The Surgical Results of Stages 2 and 3 Macular Hole With Internal Limiting Membrane Peeling and Intravitreal Air

Sung Bok Lee; Ki Yup Nam; Kyoung Nam Kim; Young Joon Jo

doi:10.3341/jkos.2009.50.7.1076

Journal List > J Korean Ophthalmol Soc > v.50(7) > 1008313

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Lee, Nam, Kim, and Jo: The Surgical Results of Stages 2 and 3 Macular Hole With Internal Limiting Membrane Peeling and Intravitreal Air

Original Article

J Korean Ophthalmol Soc 2009;50(7):1076-1081.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1076

The Surgical Results of Stages 2 and 3 Macular Hole With Internal Limiting Membrane Peeling and Intravitreal Air

Sung Bok Lee, MD, PhD, Ki Yup Nam, MD, Kyoung Nam Kim, MD, Young Joon Jo, MD

Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea

Address reprint requests to Young-Joon Jo, MD Department of Ophthalmology, Chungnam National University Hospital #640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-280-7607, Fax: 82-42-222-3853, E-mail: youngjoon@cnu.ac.kr

Received 27 November 2008 Accepted 14 April 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To examine the results of macular hole surgery using pars plana vitrectomy (PPV), triamcinolone-assisted peeling of the internal limiting membrane (ILM), and intravitreous air in idiopathic stage 2 and 3 macular holes.

Methods

Thirteen eyes of 13 consecutive patients with idiopathic macular hole underwent a PPV with triamcinolone-assisted ILM peeling and intravitreous air tamponade. An air-fluid exchange was performed and the patient was asked to maintain a face-down position at home for 4 days. The follow-up period was 6 months or more in all cases. If a significant cataract was present before surgery, a combined phacoemulsification with posterior chamber lens implantation was performed at the time of the macular hole surgery. The closure of the macular hole was determined by biomicroscopy and Optical Coherence Tomography (OCT).

Results

The idiopathic macular hole was closed after the primary operation in all 13 patients. The postoperative visual acuities (0.1 to 0.9) significantly improved from the preoperative visual acuities (0.02 to 0.4) in all eyes. There was no recurrence of the macular hole and there were no adverse effects of the intraoperative use of triamcinolone and ILM peeling during the follow-up period.

Conclusions

This study suggests that triamcinolone-assisted ILM peeling with intravitreous air may be an effective technique for stage 2 and 3 macular holes. This procedure could reduce the face-down position time and improve early visual rehabilitation by using air instead of long-acting gas tamponade.

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Keywords: Air, Internal limiting membrane, Macular hole, Triamcinolone

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Figure 1.

Summary of fundus photographs and OCT.

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Figure 2.

Preoperative and postoperative visual outcomes (LogMar, p<0.01).

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Table 1.

Patient characteristics

Case No.	Age (years)	Sex	Initial vision (log Mar)	Final Vision (log Mar)	Follow-up (months)	Cataract op	Macular hole stage	Size of macular hole (μm)
1	62	F	1.3	0.3	6	−	3	537
2	57	F	1.7	0.4	12	+	3	588
3	69	F	0.5	0.2	13	+	3	342
4	77	M	1.3	0.7	7	+	3	497
5	71	F	1.3	0.7	6	+	3	562
6	69	F	0.7	0.3	18	−	2	365
7	62	M	0.4	0.1	17	+	2	328
8	67	F	0.5	0.3	19	+	2	356
9	61	F	0.7	0.3	9	+	3	418
10	64	F	0.8	0.4	7	+	3	425
11	67	F	1.0	0.1	18	+	3	496
12	75	F	0.7	0.1	18	+	2	472
13	64	F	0.8	0.1	7	+	2	511

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Case No.	Age (years)	Sex	Initial vision (log Mar)	Final Vision (log Mar)	Follow-up (months)	Cataract op	Macular hole stage	Size of macular hole (μm)
1	62	F	1.3	0.3	6	−	3	537
2	57	F	1.7	0.4	12	+	3	588
3	69	F	0.5	0.2	13	+	3	342
4	77	M	1.3	0.7	7	+	3	497
5	71	F	1.3	0.7	6	+	3	562
6	69	F	0.7	0.3	18	−	2	365
7	62	M	0.4	0.1	17	+	2	328
8	67	F	0.5	0.3	19	+	2	356
9	61	F	0.7	0.3	9	+	3	418
10	64	F	0.8	0.4	7	+	3	425
11	67	F	1.0	0.1	18	+	3	496
12	75	F	0.7	0.1	18	+	2	472
13	64	F	0.8	0.1	7	+	2	511

Case No.	Age (years)	Sex	Initial vision (log Mar)	Final Vision (log Mar)	Follow-up (months)	Cataract op	Macular hole stage	Size of macular hole (μm)
1	62	F	1.3	0.3	6	−	3	537
2	57	F	1.7	0.4	12	+	3	588
3	69	F	0.5	0.2	13	+	3	342
4	77	M	1.3	0.7	7	+	3	497
5	71	F	1.3	0.7	6	+	3	562
6	69	F	0.7	0.3	18	−	2	365
7	62	M	0.4	0.1	17	+	2	328
8	67	F	0.5	0.3	19	+	2	356
9	61	F	0.7	0.3	9	+	3	418
10	64	F	0.8	0.4	7	+	3	425
11	67	F	1.0	0.1	18	+	3	496
12	75	F	0.7	0.1	18	+	2	472
13	64	F	0.8	0.1	7	+	2	511

Case No.	Age (years)	Sex	Initial vision (log Mar)	Final Vision (log Mar)	Follow-up (months)	Cataract op	Macular hole stage	Size of macular hole (μm)
1	62	F	1.3	0.3	6	−	3	537
2	57	F	1.7	0.4	12	+	3	588
3	69	F	0.5	0.2	13	+	3	342
4	77	M	1.3	0.7	7	+	3	497
5	71	F	1.3	0.7	6	+	3	562
6	69	F	0.7	0.3	18	−	2	365
7	62	M	0.4	0.1	17	+	2	328
8	67	F	0.5	0.3	19	+	2	356
9	61	F	0.7	0.3	9	+	3	418
10	64	F	0.8	0.4	7	+	3	425
11	67	F	1.0	0.1	18	+	3	496
12	75	F	0.7	0.1	18	+	2	472
13	64	F	0.8	0.1	7	+	2	511