Original Articles
Macular hole surgery in conjunction with endolaser photocoagulation

Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, Ft Lauderdale, Florida, May 1998.
https://doi.org/10.1016/S0002-9394(98)00409-7Get rights and content

Abstract

PURPOSE:

To determine whether endolaser photocoagulation to the retinal pigment epithelium at the base of a macular hole increases the anatomic success rate of surgery.

METHODS:

In a prospective consecutive clinical trial, eight eyes of seven patients with idiopathic macular hole underwent vitrectomy with posterior cortical vitreous removal and peeling of visible epiretinal membrane when present. A single shot of argon endolaser photocoagulation was applied to the retinal pigment epithelium at the center of the macular hole with a duration of 0.05 to 0.2 seconds and an intensity of 50 to 200 mW. After fluid-gas exchange was performed with 14% perfluoropropane gas, patients maintained face-down positioning for 2 weeks.

RESULTS:

One eye with stage 2 macular hole, six eyes with stage 3 macular hole, and one eye with stage 4 macular hole were included. All eight eyes had a closed macular hole (100% anatomic success rate) at final examination 6 to 12 months after surgery. Best-corrected visual acuity improved 3 or more lines on the Early Treatment Diabetic Retinopathy Study visual acuity chart in all eyes. Four (50%) of the eight eyes had a final visual acuity of 20/40 or better.

CONCLUSIONS:

Endolaser photocoagulation may be a useful adjunct to macular hole surgery but requires further investigation and long-term evaluation.

Section snippets

Patients and methods

This study was a prospective consecutive series of eyes treated for full-thickness macular hole with application of endolaser photocoagulation to the retinal pigment epithelium at the center of the hole. Eight eyes of seven patients with a diagnosis of stage 2 to 4 macular hole underwent macular hole surgery. Eligibility criteria included a full-thickness macular hole with a surrounding cuff of neurosensory retinal detachment. We excluded patients with predisposing factors for macular hole,

Results

All eight eyes of seven patients that underwent surgery had a closed macular hole at a mean of 8.6 months (range, 6 to 12 months) after surgery. In all eight eyes, best-corrected visual acuity improved at least 3 lines (Table). Four (50%) of the eight eyes with closed macular holes had a visual acuity of 20/40 or better 6 months after surgery. There was no significant difference related to the variables of endolaser photocoagulation.

During the laser procedure, the retinal pigment epithelium

Discussion

Kelly and Wendel3 reported that 42% of the macular holes in their study failed to close with their originally described procedure. They postulated various reasons for failure, including insufficient gas tamponade, poor patient compliance, and residual epiretinal membrane. Many investigators tried to increase the success rate of macular hole surgery by using several types of adjuncts.7, 8, 9 Glaser and associates4 reported improved results from pars plana vitrectomy in closing macular holes with

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