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Macular-hole Surgery in Presence of Advanced RPE-pathology Associated with Autosomal Dominant Pattern Dystrophy and Confluent Soft Drusen Associated with ARMD

Staudt S., Miller D., Holz F. G.,
Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)

Purpose: With the advent of vitreoretinal surgery closure of idiopathic or secondary macular holes (MH) with subsequent functional improvement is achieved in the majority of patients. However, the impact of retinal comorbidities such as pathologic alterations of the retinal pigment epithelium (RPE) on anatomic and fiunctional prognosis is unclear. We report outcome of MH surgery in presence of autosomal dominant pattern dystrophy and soft confluent drusen associated with ARMD.
Methods: MH surgical techniques included pars-plana-vitrectomy, ILM-peeling, autologous platelet concentrate and air/C2F6-tamponade with postoperative prone positioning. Pre- and postoperative examinations included digital cSLO-autofluroescence-imaging.
Results: MH closure was achieved both in a 71-old patient with advanced pattern dystrophy associated with excessive RPE lipofuscin accumulation as well as in a 79-old patient with soft confluent drusen. Visual acuity improved by 2 and 4 lines, respectively. Patial gradual drusen regression was noted during the review period of one year in the operated eye but not in the fellow eye, while the macular dystrophy remained unchanged.
Conclusion: MH surgery may be beneficial even in presence of pronounced RPE-pathology. While the precise mechanism underlying the closure of dehiscent foveal tissue is unknown, these findings indicate that normal and entirely intact RPE is not a prerequisite. Regression of soft drusen postoperatively is intriguing and may result from unspecific induction of phagocytosis by the surgical procedure.