Summary:
The aim of the study was to confirm the surgical treatment of the macular hole
by means of pars plana vitrectomy with the peeling of the internal limiting
membrane and gas tamponade by 15 % perfluoropropane.
Methods: The group consisted of 28 patients (24 women and 4 men) of the
average age 68 ∈ 6.8 years. In two patients, subsequently both eyes were
operated on. The stage of the macular hole was established according to the
clinical findings and OCT examination in accordance with the Gass’
classification. The average follow up period of this group of patients was 14.7
∈ 6.8 months. The final result of the surgery was verified at the end of the follow
up period by means of clinical and OCT examination as well. In all 28 patients
(30 eyes) with idiopathic macular hole, the standard pars plana vitrectomy with
the peeling of the posterior hyaloid was performed. After air/fluid exchange, the
trypane blue (Membrane blueTM) was applied for 2 minutes. The peeling of the
stained internal limiting membrane in the macular region was performed and
tamponade with 15 % perfluoropropane was used. The prone position of the
patient’s head for the next two weeks was recommended. At the end of the
follow up period, the best-corrected visual acuity (BCVA) was assessed.
Results: The average follow up period was 14.7 ∈ 6.8 months. The staining of the
internal limiting membrane was sufficient in all cases. The average visual acuity
before the surgery was 0.89 ∈ 0.33 logMAR (0.2 – 1.7). At the end of the follow up
period the average visual acuity was 0.67 ∈ 0.38 logMAR (0.2 ∈ 1.1). The visual
acuity improved in 77 %, was stabilized in 20 %, and worsened in 3 % of cases.
The BCVA improvement is statistically significant (p = 0.005). Metamorphopsia
disappeared in 100 % of cases. The total closure of idiopathic macular hole
(stage 1 according to Tornambe – flat/closed) was achieved in 26 eyes (87 %),
flattening of the rim (stage 2 according to Tornambe – flat/open) was achieved
in 4 eyes (13 %).
Conclusion: The pars plana vitrectomy with the peeling of the internal limiting
membrane represents an effective method of treatment of the idiopathic
macular hole. The trypane blue (Membrane blueTM) staining facilitates the
identification and delamination of the internal limiting membrane.
Key words:
idiopathic macular hole, trypane blue, pars plana vitrectomy, gas
tamponade, peeling of the internal limiting membrane, prone positioning of the
head.
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