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Functional and Aanatomical Results after Macular Hole Surgery with Peeling of the Internal Limiting Membrane: 32-Month Follow-up

Haritoglou C., Gass C. A., Schaumberger M., Kampik A.,
Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Augenklinik (München)

Purpose: To report long term anatomical and functional results after pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole.
Method: 99 patients with a period of review of at least 12 months were included. The surgical technique consisted of a standard pars plana vitrectomy with obligate removal of the ILM and an intraocular gas tamponade (15% C2F6 gas mixture). No adjuvants or dyes were used. Follow-up examinations consisted of a clinical examination, Goldmann perimetry, optical coherence tomography (OCT) and static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105). Stimulus size was 0.2°, intensities employed were 0 and 12 dB.
Results: Mean follow-up time was 32 months. Anatomic closure was achieved in 87% of patients by one surgical procedure. Nine patients underwent a successfull second operation with an improvement of visual acuity in 7 patients. The total closure rate was 96%. Median best corrected visual acuity increased from 20/100 (range 20/400 to 20/40) preoperatively to 20/40 (range 20/500 to 20/20) postoperatively (p < 0.001). An improvement of visual acuity was achieved in 94% of patients. 72 patients (73%) underwent cataract extraction later; 90 eyes (91%) were pseudophacic on last presentation. We delineated paracentral scotomata which did not change in size, density or shape over time. The incidence of paracentral scotomata was not correlated with the stage of the macular hole. No postoperative epiretinal membrane formation or late reopenings were observed. The incidence of peripheral visual field defects was 1%.
Conclusions: Macular hole surgery with peeling of the ILM without the use of adjuvants or ILM staining leads to good functional long term results. Paracentral scotomata remained subclinical in most cases and may be due to a mechanical trauma of the nerve fiber layer.