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Hole Surgery (hole + surgery)
Kinds of Hole Surgery Selected AbstractsSulfur hexafluoride (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgeryACTA OPHTHALMOLOGICA, Issue 2009M STEFANIOTOU Purpose In Macular Hole surgery gas tamponade is hypothesized to enhance macular hole closure after removal of tangential force. Sulfur hexafluoride (SF6) was described in the initial report of Macular Hole surgery (MHS). Long lasting gas (such as C3F8) may offer more extensive tamponade . To compare outcomes of Macular Hole Surgery using SF6 gas versus C3F8 gas for idiopathic macular hole repair. Methods A consecutive group of patients undergoing MHS with SF6 group A (24 eyes of 24 patients) and a consecutive comparison group B with S3F8 was used (19 eyes of 19 patients). All patients had PP Vitrectomy, ILM peeling, using Kenacort or Blue and two different gases for internal tamponade. Results The macular hole closure rate was similar in both groups. Conclusion Macular Hole surgery using SF6 gas yields similar results as with C3F8 gas and may be a good option. [source] Retinal sensitivity and fixation changes 1 year after triamcinolone acetonide assisted internal limiting membrane peeling for macular hole surgery , a MP-1 microperimetric studyACTA OPHTHALMOLOGICA, Issue 6 2010Hakan Ozdemir Acta Ophthalmol. 2010: 88: e222,e227 Abstract. Purpose:, To evaluate microperimetric changes 1 year after macular hole surgery with triamcinolone acetonide assisted internal limiting membrane (ILM) peeling. Methods:, Twenty-two eyes of 22 patients with stage 3 and 4 idiopathic macular holes of <6 months' duration underwent vitrectomy with triamcinolone acetonide assisted ILM peeling. Best corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution), and central retinal sensitivity were documented before and 1, 3, 6, and 12 months after surgery. Macular sensitivity (mean sensitivity in decibels -dB), and stability and location of fixation (preferred retinal locus) were determined using MP-1 microperimetry (Nidek). The MP-1 microperimetry sensitivity map was overlaid onto infrared images recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the fixation location before surgery. Anatomical success was evaluated with optical coherence tomography (OCT). Optical coherence tomography scans were recorded on an OCT 3000 scanner. Results:, Anatomical success was achieved in all 22 eyes. All patients completed 1 year follow-up. No recurrence of macular hole was seen in any patients in the follow-up period. The mean BCVA improved from 0.75 ± 0.2 before surgery to 0.31 ± 0.1 logMAR at the last visit (p < 0.001). Mean sensitivity improved from 3.7 ± 0.6 to 5.3 ± 1.0 dB at the last visit (p < 0.001). Before surgery, the preferred retinal locus was located on the margin of the hole in all, in 18 eyes on its upper part and in four eyes to the side or on its lower part. Preoperatively, 12 eyes were stable and 10 were relatively unstable, but 12 month after surgery, fixation stability had improved, and 20 eyes were stable and two were relatively unstable. Conclusions:, MP-1 microperimetry sensitivity map overlaid onto an infrared image using dedicated MP-1 software can be used successfully to evaluate fixation location in patients with a macular hole before surgery. With microperimetry findings, we can also measure functional macular changes more precisely than using BCVA alone after macular hole surgery. Our results also showed that retinal sensitivity and fixation properties were improved after vitrectomy with triamcinolone acetonide assisted ILM peeling in patients with idiopathic macular hole. [source] Use of heavy silicone oil (Densiron-68®) in the treatment of persistent macular holesACTA OPHTHALMOLOGICA, Issue 8 2009Alexandra Lappas Abstract. Purpose:, In this retrospective case series, we studied the effect of ,heavy' silicone oil on persisting macular holes. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade Densiron-68®. Methods:, Twelve patients with primary macular holes that persisted after pars plana vitrectomy, peeling of the internal limiting membrane and internal gas tamponade with SF6 (sulphur hexafluoride) were retreated with heavy silicone oil, Densiron-68®, in the University Eye Hospital, Cologne. After 1.5,4 months the Densiron-68® was removed. Best corrected visual acuity (VA), slit-lamp examination, binocular fundus examination and optical coherence tomography (OCT) were used for evaluation pre- and postoperatively. The follow-up period was 3,7 months. Results:, Preoperatively, all patients displayed full-thickness macular holes, with a mean size of 502.25 ,m (± 129.39 ,m). Postoperatively, 11 of 12 macular holes were closed. One patient experienced a reopening of the macular hole. Mean VA was 20/250 (1.07 ± 0.22 logMAR) prior to treatment with Densiron-68® and 20/160 (0.84 ± 0.24 logMAR) postoperatively. Visual acuity increased from baseline in nine patients and decreased in one. Conclusions:, Retreatment of persisting macular holes with the heavy, longterm tamponade Densiron-68® resulted in anatomical closure of the hole in 11 of 12 cases. This result was accompanied by a functional improvement in VA in nine of 12 patients. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] Macular hole surgery with and without internal limiting membrane peelingACTA OPHTHALMOLOGICA, Issue 2009C KOURENTIS Purpose To compare the results of surgery for idiopathic macular hole with or without the surgical removal of the internal limiting membrane (ILM) and the effect on anatomical and functional success rates. Methods 41 consecutive patients with idiopathic macular hole stage II (n=11), III (n=22) and IV (n=8) underwent pars plana vitrectomy and intraocular gas tamponade in this study. The surgery was performed either with ILM peeling,Group A (n=28), or without, Group B (n=13). Ocular coherence tomography and ETDRS visual acuity were measured pre- and postoperatively to assess macular hole size and anatomical hole closure as well as visual function. Results The postoperative macular hole closure rate was 100% (28/28) in Group A and 84,6% (11/13) in Group B. The 2 cases that failed to close with primary surgery had a hole size greater than 400µm. There was no significant difference between the two groups in the postoperative visual outcome once anatomical success was achieved. Conclusion The study suggests that more evidence based trials are necessary to investigate the benefit of ILM peeling especially in the treatment of larger macular holes. [source] Internal limiting membrane stainingACTA OPHTHALMOLOGICA, Issue 2009J KATSIMPRIS Purpose To describe the different modalities of internal limiting membrane (ILM) staining for the treatment of idiopathic macular hole (IMH). Methods Search of the MEDLINE database by using Medical Subject Heading search terms and key words related to ILM staining, macular hole surgery. Results ILM removal has been closely related with increased closure rates. However, because of poor ILM visibility the surgical removal of ILM is very difficult and poses serious complications. To obtain better visibility of ILM some special techniques have been developed using specific dyes such as, trypan blue (TB), indocyanine green (ICG), infracyanine green or triamsinolone acetonide(TA). Anatomic success rates with one surgery have increased (>90%) however, concern for toxicity has emerged. Patients with ICG-assisted ILM peeling appear to have a depressed recovery of visual acuity compared to those not using ICG. Concentrations of ICG that are <0.5 mg/mL have been shown to be non-toxic in cultures of RPE cells. Infracyanine green is a similar molecule that does not contain iodine and is less likely to induce osmolarity related toxic effects on the PRE cells when compared to ICG. It has been used also for ILM staining in combination with trypan(TB). TB is a second generation vital dye that stains epiretinal membranes (ERMs) directly and ILM to a lesser extent. Thus TB is useful for both macular hole and macular pucker surgery. TA may be also used to help highlight the ILM, although it is not a dye. It does adhere to the posterior hyaloid, making the detection of ILM easier. Conclusion This review largely reflects the great advent of different techniques for ILM staining. The use of ICG is more toxic when compared with TB. For TA long-term effects have not been well studied. [source] 23G versus 20G for macular hole surgery.ACTA OPHTHALMOLOGICA, Issue 2009Efficacy, patient satisfaction, safety Purpose To compare the 20gauge and 23gauge vitreoretinal surgical system and equipment in macular hole surgery. Methods We randomly assigned 38 patients in two different groups. Group 1. Used 20g surgical equipment and instrumentation. Group 2. Used 23g surgical equipment and instrumentation. All cases were operated by the same surgeon. The efficacy, the safety and the patient comfort were evaluated. Results No statistically significant difference found between the two groups regarding efficacy and complications. Group 2 was superior to group 1 regarding patient satisfaction (p<0.005). Conclusion 23g surgical equipment offers similar efficacy to the established 20g equipment for macular hole surgery. Though reduces the intraoperative time and patient overall satisfaction is greater. [source] Face down posturing for macular hole surgery.ACTA OPHTHALMOLOGICA, Issue 2009Is it really required? Purpose Background: In macular hole surgery pars plana vitrectomy and intravitreal gas injection with or without inner limiting membrane peel, is considered the mainstay of treatment. The requirement for face down posturing is generally regarded as part of the traditional postoperative routine. Several mechanisms have been postulated to explain the action of the gas bubble including exertion of a large floatation force on the macula and prevention of the macular hole exposure to vitreous fluid. Recently the need to face down has been chalenged since this regime compromises patients' postoperative quality of life and it makes macular hole surgery almost impossible for individuals with mental or physical limitations. Methods Review of personal data and systermatic literature review of studies investigating macular hole surgery with shortened or eliminated face down posturing. Results There is considerable body of evidence suggesting successful anatomical and functional outcome in patients with shorter duration of posturing or no posturing at all following macular hole surgery. The pros and cons of each technique will be presented in detail. Conclusion Prone posturing following macular hole surgery provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for phakic patients undergoing macular hole surgery. [source] Sulfur hexafluoride (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgeryACTA OPHTHALMOLOGICA, Issue 2009M STEFANIOTOU Purpose In Macular Hole surgery gas tamponade is hypothesized to enhance macular hole closure after removal of tangential force. Sulfur hexafluoride (SF6) was described in the initial report of Macular Hole surgery (MHS). Long lasting gas (such as C3F8) may offer more extensive tamponade . To compare outcomes of Macular Hole Surgery using SF6 gas versus C3F8 gas for idiopathic macular hole repair. Methods A consecutive group of patients undergoing MHS with SF6 group A (24 eyes of 24 patients) and a consecutive comparison group B with S3F8 was used (19 eyes of 19 patients). All patients had PP Vitrectomy, ILM peeling, using Kenacort or Blue and two different gases for internal tamponade. Results The macular hole closure rate was similar in both groups. Conclusion Macular Hole surgery using SF6 gas yields similar results as with C3F8 gas and may be a good option. [source] Persistence of triamcinolone acetonide following macular hole surgeryACTA OPHTHALMOLOGICA, Issue 5 2006Yukihide Yamauchi No abstract is available for this article. [source] Vitrectomy without postoperative posturing for idiopathic macular holesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2007Adrian Rubinstein MRCSEd Abstract Purpose:, To determine the success of vitrectomy with ILM peeling and C3F8 tamponade for macular holes without the need for postoperative face-down posturing. Methods:, Twenty-four eyes of 24 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and C3F8 tamponade without prone posturing were included in the study. All patients had follow up on 1 day, 2 weeks and 3 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre- and postoperatively. Results:, Of the 24 eyes recruited, two (8%) had stage II, 17 (71%) had stage III and five (21%) had stage IV macular holes. Nineteen (79%) eyes were phakic and five (21%) eyes were pseudophakic at the time of surgery. The macular holes had been present for an average of 7.5 months (range 3,18 months). At 3-month follow up, 22/24 (91.6%) holes were closed. Both of the two holes that failed to close were stage IV macular holes. Preoperative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Postoperative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Eighteen eyes had improvement of visual acuity of at least one line on the Snellen chart, six eyes had no improvement. No eyes had worse vision postoperatively. Conclusion:, Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing. [source] Visual outcome with macular hole surgeryCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2007Philip J Polkinghorne FRANZCO No abstract is available for this article. [source] Protecting the retinal pigment epithelium during macular hole surgeryCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2005Jeffrey L Olson MD Abstract Herein a new surgical technique used during pars plana vitrectomy with internal limiting membrane peeling for macular hole surgery is reported. Perfluorocarbon liquid is used to tamponade the macular hole in order to prevent indocyanine green contact with the retinal pigment epithelium. [source] The macular hole: report of an Australian surgical series and meta-analysis of the literatureCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2000H K Kang MB BS ABSTRACT Purpose: To report an Australian series of macular hole surgery by pars plana vitrectomy and fluid-gas exchange, and to identify factors influencing the outcome of the surgery through meta-analysis of the literature. Methods: Fifty-six consecutive cases of macular hole were treated by pars plana vitrectomy, fluid-gas exchange and face-down positioning for at least 7 days, and prospectively followed for 3,12 months. Thirty-six reports of macular hole surgery were reviewed. A meta-analysis on the pre- and postoperative parameters was performed on 389 cases, in which case-specific data-points were available. Results: In the current series, anatomical closure was achieved in all (100%) of 16 stage 2, and in 35 (87.5%) of 40 stage 3 or 4 macular holes. At least 2 logMAR lines of improvement in visual acuity were seen in 10 (62.5%) stage 2 and 20 (50.0%) stage 3 or 4 holes. Postoperative visual acuity was 6/12 or better in 10 (62.5%) stage 2 and 17 (42.5%) stage 3 or 4 holes. In both the current series and the meta-analysis, favourable surgical outcomes were associated with stage 2 macular holes, better preoperative visual acuity, and shorter preoperative duration. Adjuvant use was associated with a higher rate of anatomical closure but there was no clear benefit in terms of postoperative visual acuity. Conclusion: Our experience and the results of the meta-analysis suggest that macular hole surgery should be offered as early as possible once full-thickness neuroretinal defect occurs. [source] | ||||||||||