Elsevier

Ophthalmology

Volume 107, Issue 8, 1 August 2000, Pages 1607-1611
Ophthalmology

A new approach to stage 3 macular holes22

Presented in part at the annual meeting of the American Academy of Ophthalmology, October 1999, Orlando, Florida.
https://doi.org/10.1016/S0161-6420(00)00210-4Get rights and content

Abstract

Purpose

The purpose of this article is to demonstrate the feasibility of a surgical approach that might be possible in an office setting for idiopathic stage 3 macular holes. The posterior hyaloid of the vitreous and perihole tissue is enzymatically manipulated to create an atraumatic posterior vitreous separation and may stimulate cell proliferation to close macular holes.

Design

Prospective noncomparative interventional case series.

Participants

Nine eyes of eight patients with idiopathic stage 3 macular holes were treated.

Methods

The patients were treated with an injection of 0.4 IU of autologous plasmin enzyme into the midvitreous cavity and lavage of the vitreous cavity with an infusion light pipe and vitreous cutter followed by filling 70% to 80% of the vitreous cavity with 14% C3F8 and head-down positioning.

Main outcome measures

Posterior vitreous detachment, macular hole closure, and vision improvement.

Results

Eight of nine eyes showed a spontaneous posterior vitreous detachment. One eye required minimal suction of less than 50 mmHg to elevate the posterior hyaloid off the retinal surface. Eyes were followed for a minimum of 6 months. All holes closed, and there was an average visual acuity improvement of four lines. The average surgical time for this procedure was 20 minutes.

Conclusions

Autologous plasmin enzyme–assisted vitreous surgery techniques can reduce operative time, expense, and patient inconvenience while maintaining excellent surgical results, which may allow office-based vitreous surgery for idiopathic stage 3 macular holes.

Section snippets

Patient selection

Nine eyes of eight patients were studied. Seven patients were women and one patient was a man. Age range was 61 years to 82 years, with an average age of 66 years at time of surgery. Seven patients were Caucasian, and one patient was African American. All patients had a complete ocular examination preoperatively, including a 90 diopter lens and Goldmann contact lens examination of the vitreous and macular hole. Watzke-Allen slit sign testing and peripheral retinal examination were performed.

Intraoperative observations

In all nine eyes the sterility cultures were negative at 48 hours. Eight of nine eyes had spontaneous PVD across the entire macula. Two of these eight eyes had minimal attachment (less than three clock hours) in the area of the Weiss ring at the optic disc. One eye required low (50 mmHg) suction delivered 3 mm from the retinal surface to peel the hyaloid off the macula and posterior pole. No peeling of the perihole tissue was performed in any eye.

Liquefaction of the vitreous cavity was graded

Discussion

Recently, idiopathic stage 3 macular holes have become a common indication for conventional vitreoretinal surgery. This surgery has a high anatomic and visual success rate ranging from 45% to 100% hole closure and from 42% to 100% visual success as defined by improvement of two lines of vision or more.1, 3, 11 It does, however, have an impact on the patient, requiring at least outpatient hospitalization and face-down positioning for 1 to 2 weeks postoperatively. We have reported our experience

References (16)

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1

Received October 24, 1999. Accepted April 4, 2000.

2

Drs. Trese, Williams, and Hartzer have a financial interest in plasmin enzyme (Use Patent.)

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