A new approach to stage 3 macular holes22
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)
- et al.
Vitreous surgery for macular holes
Ophthalmology
(1993) - et al.
Plasmin enzyme-assisted vitrectomy in traumatic pediatric macular holes
Ophthalmology
(1998) - et al.
Vitrectomy, fluid-gas exchange and transforming growth factor-beta-2 for the treatment of traumatic macular holes
Ophthalmology
(1995) Dehydration injury as a possible cause of visual defect after pars plana vitrectomy for macular hole
Am J Ophthalmol
(1997)- et al.
Vitreous surgery for idiopathic macular holes. Results of a pilot study
Arch Ophthalmol
(1991) - et al.
Vitrectomy for impending idiopathic macular holes
Am J Ophthalmol
(1988) Idiopathic senile macular hole. Its early stages and pathogenesis
Arch Ophthalmol
(1988)- et al.
Visual field defects after macular hole surgery. A new finding
Ophthalmology
(1996)
Cited by (92)
Vitreomacular Adhesion and Neovascular Age-Related Macular Degeneration
2012, Survey of OphthalmologyIdiopathic Full-Thickness Macular Holes and the Vitreomacular Interface: A High-Resolution Spectral-Domain Optical Coherence Tomography Study
2012, American Journal of OphthalmologyCitation Excerpt :The current study provided additional information of the vitreomacular interfaces in stage 2 and 3 MHs that can be added to the Gass classification.7,8 This information may lead to a better understanding of the entities and may assist in future research and the development of new pharmacologic therapies.57–60 In the future, the current study will be extended to determine how these differences in the vitreomacular interfaces are actually related to the postoperative visual function.
Macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment of patients with a unilateral macular hole
2011, American Journal of OphthalmologyCitation Excerpt :Therefore, patients with such foveal lesions and a perifoveal PVD observed in the fellow eyes on OCT must be followed closely. The pharmacologic creation48–50 or induction of an expansile gas bubble51,52 of vitreomacular separation may alleviate the need for surgery in certain cases, notably in eyes with an early-stage macular hole.50–52 Avoiding vitrectomy may provide better visual results and a lower treatment burden.
Surgical Decision Making in Pediatric Retinal Diseases
2023, Pediatric Vitreoretinal SurgeryShort-term results of ocriplasmin versus prompt vitrectomy for macular hole. Which performs better?
2020, Journal of Clinical Medicine
- 1
Received October 24, 1999. Accepted April 4, 2000.
- 2
Drs. Trese, Williams, and Hartzer have a financial interest in plasmin enzyme (Use Patent.)