Article
Surgical treatment of macular hole without postoperative vitreous cavity tamponade
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Published: | May 14, 2019 |
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Purpose: To present the technique of macular hole surgery without vitreous cavity tamponade with gas or another vitreous substitute in post-op period.
Setting/venue: IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia
Methods: Fourteen eyes of 14 patients were operated for full-thickness macular holes 100 to 700 (442.6±54.5) microns in diameter. BCVA was 0.04 to 0.2 (0.09±0.01). The operation included 3-port 25-27 G vitrectomy, separation of posterior hyaloid. ILM was stained and removed, BSS – air exchange was performed, hole edges were passively pulled towards the center with extrusion cannula and air supply into the vitreous cavity under pressure of 20-25 mm Hg without mechanical closure. Immediately 0.1 ml of platelet rich plasma (PRP) was applied to macular hole zone. In 2 minutes, fibrin film was formed at the place of application which was pressed to the retina by injection of 0.3 ml of PFCL into the vitreous cavity. PFCL exposure was 5 minutes, then PFCL was passively aspirated with exchange for air. The operation was finished by air exchange for BSS. High specific weight of PFCL facilitated tight adhesion of fibrin film to the retina; due to this the film held to the retina during PFCL exchange for air and then for BSS. Follow-up period of the patients made 2 weeks to 4 months.
Results: No intraoperative and postoperative complications were seen. In the result of surgery complete closure of the macular hole and anatomical restoration of the macula was achieved in 13 of 14 cases (92.8%). A recurrence in one case was associated with a violation of operation technology when a partial mechanical displacement of the fibrin film with a cannula during PFCL exchange for air occurred. After modification of operation technique, no cases of fibrin film displacement were marked. Postoperative BCVA was 0.2 to 0.6 (0.4±0.04).
Conclusions: The suggested method of macular hole surgery without postoperative tamponade of the vitreous cavity with gas or another vitreous substitute may be used in routine clinical practice.