Photocoagulation and fluid—gas exchange to treat persistent macular holes after prior vitrectomy: A pilot study1Historical vignette☆,
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Patients and methods
We retrospectively reviewed the records of 13 eyes of 12 patients with persistent macular holes after initial vitrectomy who underwent photocoagulation of the RPE in the hole bed followed by FGX at either Osaka National Hospital or Osaka University Medical School from August 1995 to July 1996. One case (case 2) had been reported previously.11 The study group consisted of nine women and three men (age range, 55–74 years; 64.2 ± 7.5, mean ± standard deviation [SD]). Before the initial vitrectomy,
Initial successes
To evaluate the potential efficacy of photocoagulation and FGX, we also reviewed the records of 73 eyes of 70 patients who underwent initial vitrectomy for idiopathic macular holes during the same time period at the same institutions. The patient data and surgical results of these eyes were compared with those of patients treated with photocoagulation and FGX.
Of those eyes initially treated, 47 (82%) of 57 eyes (47 patients; 32 women, 15 men) with more than 3 months’ follow-up were treated
Operations before photocoagulation and fluid-gas exchange
Of the 13 study eyes that underwent photocoagulation and FGX, vitrectomies before photocoagulation were performed at either the Osaka University Medical School or the Osaka National Hospital. A three-port system was used in all vitrectomies. A core vitrectomy was performed, followed by separation and removal of the posterior vitreous cortex from the optic nerve head and macula using a flexible cannula. Special effort was made to ensure that all adherent vitreous was removed from the neural
Statistical analysis
Using Fisher’s exact test, we analyzed the patient data, including age, gender, duration of symptoms, and preoperative visual acuities; type of gas used during initial vitrectomy; and visual outcomes as a comparison between the eyes that underwent a successful initial vitrectomy and those that underwent an unsuccessful initial macular hole surgery but were treated successfully with photocoagulation and FGX; P <0.05 was considered significant.
Case 8
A 65-year-old man was referred to the Osaka National Hospital in August 1994 for visual loss of 2 weeks’ duration in his left eye. Best-corrected visual acuity was 20/20 in the right eye and 20/40 in the left eye. Intraocular pressure was normal bilaterally. A mild cataract was present on the slit-lamp examination in the left eye. Biomicroscopic fundus examination results showed a stage III macular hole in the left eye. The diameter of the hole was 300 μm. One week later, we performed
Results
Patient data are listed in Table 1. The pretreatment visual acuity levels ranged from 2/200 to 20/50, and the intervals from the previous vitrectomy to treatment ranged from 1 to 4 months (1.2 ± 0.8, mean ± SD). The persistent macular holes were all full thickness with diameters ranging from 250 to 650 μm (480 ± 160, mean ± SD) before the initial vitrectomy and from 290 to 820 μm (610 ± 190 mean ± SD) before photocoagulation. Pretreatment lens status was as follows: clear lens in four eyes
Discussion
The persistence of a macular hole after vitrectomy is one of the major complications of this type of surgery, although it occurs in a minority of cases. Kelly and Wendel3 reported that 125 (73%) of 170 study eyes achieved anatomic success, with 45 (27%) of 170 holes failing to close. More recent studies have reported higher success rates, but surgical failures are present in nearly every series to date. In the current series, successful hole closure was achieved after 1 operation in 47 (82%) of
Acknowledgements
The authors thank Dr. John Michael Lewis, Retinal Diagnostic Center, San Jose, California, for his assistance.
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Supported in part by a grant from the Osaka Eye Bank, Osaka, Japan.
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None of the authors has financial interest in products or devices used in this study.