Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade
Authors:
M. Veith; Z. Straňák; M. Penčák; P. Studený
Authors‘ workplace:
Oftalmologická klinika FN Královské Vinohrady a 3. LF UK, Praha, přednosta prof. MUDr. Pavel Kuchynka, CSc.
Published in:
Čes. a slov. Oftal., 71, 2015, No. 3, p. 170-174
Category:
Original Article
Overview
25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade for idiopatic macular hole
Purpose:
The evaluation of anatomic and visual outcomes in idiopatic macular holes treated with 25-gauge pars plana vitrectomy, briliant blue (BB) assisted internal limiting membrane (ILM) peeling and gas tamponade.
Materials and methods:
Retrospective analysis. 53 eyes of 52 patients (39 women, 13 men) of mean age 68,8 years (58-83) with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification from 6/2012 to 7/2014 were included. All patient undergone 25-gauge pars plana vitrectomy with brillinat blue assisted ILM peeling, gas tamponade (35 cases 15 % C3F8, 18 cases 20 % SF6). 50 cases (94,3 %) were performed in retrobulbar anesthesia, 3 cases in general anesthesia. Face-down positioning should have beeen maintained for three days. Best corrected visual acuity (BCVA), optical coherence tomography findings and complications were evaluated.
Results:
The mean follow-up time was 6 months (1–22). Macular hole closure was achieved in 49 eyes (92,5 %). The mean BCVA improved from 0,16 (0,5–0,05) to 0,5 (1,0–0,1). BCVA was improved by 3 and more ETDRS lines in 42 eyes (79,2 %).
Conclusion:
25-gauge pars plana vitrectomy with briliant blue assisted internal limiting membrane peeling and gas tamponade is safe and effective method of macular hole therapy with high anatomic and functional effect.
Key words:
macular hole, 25-gauge, ILM peeling, brilliant blue, gas tamponade
Sources
1. Al-Abdulla NA., Thompson JT., et al.: Results of macular hole surgery with and without epiretinal dissection or internal limiting membrane removal. Ophthalmology, 2004; 111(1): 142–149.
2. Allen C. HO et al.: Macular Hole. Survey of Ophthalmology, Volume 42, Number 5, March-April 1998.
3. Almeida DR., Wong J., et al.: Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning. Retina, 2012 Mar; 32(3): 506–10.
4. Benson WE., Cruickshanks KC., et al.: Surgical management of macular holes: a report by the American Academy of Ophthalmology. Ophthalmology, 2001; 108(7): 1328–1335.
5. Beutel J., Dahmen G., et al.: Internal limiting membrane peeling with indocyanine green or trypan blue in macular hole surgery: a randomized trial. Arch Ophthalmol, 2007; 125(3): 326–332.
6. Brooks HL. Jr.: Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology. 2000;107(10): 1939–1948.
7. de Bustros S.: Vitrectomy for prevention of macular holes. Results of a randomized multicenter clinical trial. Vitrectomy for Prevention of Macular Hole Study Group. Ophthalmology, 1994 Jun; 101(6): 1055-9.
8. Enaida H., Hisatomi T., et al.: Preclinical investigation of internal limiting membrane peeling and staining using intravitreal brilliant blue G. Retina, 2006, 26(6): 623–630.
9. Enaida H., Hisatomi T., et al.: Brilliant blue G selectively stains the internal limiting membrane. Retina. 2006; 26(6): 631–636.
10. Ferencz M., Somfai GM., et al.: Functional assessment of the possible toxicity of indocyanine green dye in macular hole surgery. Am J Ophthalmol, 2006; 142(5): 765–770.
11. Forsaa VA., Raeder S., et al.: Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery. Acta Ophthalmol, 2013 Sep; 91(6): 547-51.
12. Foulquier S., Glacet-Bernard A., et al.: Study of internal limiting membrane peeling in stage-3 and -4 idiopathic macular hole surgery. French. J Fr Ophthalmol, 2002; 25(10): 1026–1031.
13. Gass JD.: Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol, 1988 May; 106(5): 629–39.
14. Haritoglou C., Ehert O., et al.: Paracentral scotoma: a new finding after vitrectomy for idiopathic macular hole. Br J Ophthalmol, 2001; 85(2): 231–233.
15. Haritoglou C., Eibl K., et al.: Functional outcome after trypan blue-assisted vitrectomy for macular pucker: a prospective, randomized, comparative trial. Am J Ophthalmol, 2004; 138(1): 1–5.
16. Haritoglou C., Reiniger IW., et al.: Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study. Retina 2006; 26: 618–22.
17. Hasegawa Y., Hata Y., et al.: Equivalent tamponade by room air as compared with SF(6) after macular hole surgery. Graefes Arch Clin Exp Ophthalmol, 2009 Nov; 247(11): 1455–9.
18. Hassan T., Williams GA.: Counterpoint: To peel or not to peel: is that the question? Ophthalmology, 2002; 109(1): 11–12.
19. Hejsek L., Langrová H., et al.: Příspěvek k vyšetřování funkce makulární krajiny při chirurgické léčbě idiopatické makulární díry. Čes a slov Oftal, 67, 2011, No. 5–6, p. 159–164.
20. Hisatomi T., Enaida H., et al.: Staining ability and biokompatibility of brilliant blue G: preclinical study of brilliant blue G as an adjunct for capsular staining. Arch Ophthalmol, 2006; 124(4): 514–519.
21. Cha DM., Woo SJ., et al.:Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol, 2013 Jun; 251(6): 1469–74.
22. Iezzi R, Kapoor KG.: No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes. Ophthalmology, 2013 Oct; 120(10): 1998–2003.
23. Jaycock PD., Bunce C., et al.: Outcomes of macular hole surgery: implications for surgical management and clinical governance. Eye, 2005; 19: 879–84.
24. Kalvodová B., Karel I., et al.: Operace katarakty u vitrektomovaných očí pro idiopatickou makulární díru. Čes a Slov Oftal, 2001, No. 2, 75–79.
25. Kaňovský R., Jurečka T., et al.: Analýza prognostických faktorů anatomického a funkčního výsledku operace idiopatické makulární díry. Čes a Slov Oftal, 65, 2009, No. 3, 91–96.
26. Karel I., Kalvodová B., et al.: Vitrektomie a koncentrát autologníchtrombocytů v léčbě idiopatických makulárních děr. Čes a Slov Oftal, 1999, No. 4, 191–202.
27. Kelly NE., Wendel RT.: Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991; 109(5): 654–659.
28. Kolář P., Vlková V.: Dlouhodobé výsledky chirurgického řešení idiopatické makulární díry s peelingem vnitřní limitující membrány. Čes a slov Oftal, 62, 2006, No. 1, 34–41.
29. Korda V., Dusová D., et al.: Chirurgické řešení makulární díry. Čes. a slov. Oftal., 61, 2005, No. 5, 316–320.
30. Krásnik V., Strmeň P., et al.: Dlhodobé sledovanie zrakových funkcií po anatomicky úspešnej chirurgickej liečbe idiopatickej diery makuly. Čes a slov Oftal, 2001, No. 2, 80–87.
31. Kuhn F.: To peel or not to peel, that is the question. Ophthalmology, 2002; 109(1):9–11.
32. Kwok AK., Lai TY., et al.: Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling. Clin Experiment Ophthalmol, 2003; 31(6): 470–475.
33. Kwok AK., Yeung CK., et al.: Effects of trypan blue on cell viability and gene expression in human retinal pigment epithelial cells. Br J Ophthalmol, 2004; 88(12): 1590–1594.
34. Le Rouic JF., Becquet F., et al.: Does 23-gauge sutureless vitrectomy modify the risk of postoperative retinal detachment after macular surgery? A comparison with 20-gauge vitrectomy. Retina, 2011 May; 31(5): 902–8.
35. Maier MM., Rass S., et al.: Transconjunctival sutureless pars plana vitrectomy and Brilliant Peel (BP)-assisted ILM peeling in patients with macular holes.Klin Monbl Augenheilkd. 2013 Jul;230(7): 701–6.
36. Nadal J., Delas B., et al.: Vitrectomy without face-down posturing for idiopathic macular holes. Retina. 2012 May; 32(5): 918–21.
37. Polk TD., Smiddy WE., et al.: Bilateral visual function after macular hole surgery. Ophthalmology, 1996; 103: 422–6.
38. Rizzo S., Belting C., et al.: Incidence of retinal detachment after small-incision, sutureless pars plana vitrectomy compared with conventional 20-gauge vitrectomy in macular hole and epiretinal membrane surgery. Retina, 2010 Jul-Aug; 30(7): 1065–71.
39. Rodrigues EB., Maia M., et al.: Vital dyes for chromovitrectomy. Curr Opin Ophthalmol. 2007;18(3):179–187.
40. Sanisoglu H., Sevim MS., et al.: Outcomes of 23-gauge pars plana vitrectomy and internal limiting membrane peeling with brilliant blue in macular hole. Clin Ophthalmol, 011;5: 1177–83.
41. Scott IU, Moraczewski AL, et al.: Longterm anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery. Am J Ophthalmol. 2003;135(5):633–640.
42. Schubert HD., Kuang K., et al.: Macular holes: migratory gaps and vitreous as obstacles to glial closure. Graefes Arch Clin Exp Ophthalmol. 1997; 235: 523–529.
43. Smiddy WE., Feuer W., et al.: Internal limiting membrane peeling in macular hole surgery. Ophthalmology, 2001; 108: 1471–8.
44. Spiteri Cornish K., Lois N., et al.: Vitrectomy with internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole. Ophthalmology, 2014 Mar; 121(3): 649–55.
45. Stalmans P., Benz MS., et al.: MIVI-TRUST Study Group. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med, 2012 Aug 16; 367(7): 606–15.
46. Stanescu-Segall D., Jackson TL.: Vital staining with indocyanine green: a review of the clinical and experimental studies relating to safety. Eye (Lond). 2009;23(3):504–518.
47. Tsuiki E., Fujikawa A., et al.: Visual field defects after macular hole surgery with indocyanine greenassisted internal limiting membrane peeling. Am J Ophthalmol, 2007;143(4): 704–705.
48. Usui H., Yasukawa T., et al.: Comparative study of the effects of room air and sulfur hexafluoride gas tamponade on functional and morphological recovery after macular hole surgery: a retrospective study.Ophthalmic Res, 2013; 50(4): 227–30.
49. Wimpissinger B., Kellner L., et al.: 23-Gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol, 2008 Nov; 92(11): 1483–7.
50. Yip HK., Lai TY., et al.: Retinal ganglion cell toxicity caused by photosensitizing effects of intravitreal indocyanine green with illumination in rat eyes. Br J Ophthalmol, 2006; 90(1): 99–102.
Labels
OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2015 Issue 3
Most read in this issue
- Intrinsically Photosensitive Retinal Ganglion Cells
- Functional Magnetic Resonance Imaging in Selected Eye Diseases
- Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade
- Stereotactic Rediosurgery for Uveal Melanoma; Postradiation Complications