Idiopathic Macular Holes in Early Stage 2 Surgery Without Internal Limiting Membrane Peeling and Without Routine a Long Duration Gas Tamponade

Tie-Ying Zhao, MD, PhD; Ming Li, MD; Ning Fan, MD; Hong-Bo Cheng MD,PhD. Shenzhen

Ophthalmic Center, Medical College of Jinan University. Shenzhen Eye Hospital, Shenzhen 518001, P.R. China

Corresponding author : zhaotieying2007@ hotmail.com

Objectives: To primarily evaluate the efficacy and safety of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling and without intraocular long-action gas tamponade for idiopathic macular hole(IMH) in early stage 2.

Patients and Methods: There were 54 eyes of 52 patients studied. The patients range in age from 59 to 76 years, mean 64.7 years(Air group) and 65.1 years(Gas group). 54 eyes of 52 patients with idiopathic macular hole in stage 2: full-thickness dehiscence underwent conventional pars plana vitrectomy with stripping and excising residual attached the posterior cortical hyaloid. Air-fluid exchanging was performed using room air(Air group:33 eyes ) or 16%C3F8 (Gas group:21 eyes). All the air group patients were prone positioning for 3or 4 days. The patient of Gas group were prone positioning for 7or 10 days. All eyes were examined with Optical Coherence Tomography (OCT) and other routine eye examinations before and after surgery. Follow-up data at 5 days to 12 months postoperatively were recorded and analyzed.

Results: Mean preoperative inside diameter of macular fovea dehiscence was 153μm in Air group and 149μm in Gas group (P=0.782,range from 93μm to 263μm). Mean preoperative bottom diameter was 261μm in Air group and 249μm in Gas group (P=0.681, range from 209μm to 520μm ) . Dilated fundus examination revealed no other obviously abnormal. Postoperatively, the inside dehiscence of the holes attained anatomical closure following surgery 5 days later in 54 (100%) of 54 eyes. Meanwhile, there was still subretinal space under the connected macular tissue. It can gradually close in follow-up time. The macular fovea recovered to normal configuration. The mean visual acuity improved from 20/113 (20/200 to 20/40) to 20/25 (20/30 to 20/20) . 2 eye (3.7%) was found a peripheral tear after vitrectomy during operation, was treated by laser. There is no advent events occur in the macular region during and after surgery.

Conclusions: This study is finding the idiopathic macular hole in early stage 2 surgery with vitrectomy relieving the traction on the edge of the hole and with air tamponade, followed by 3or4 days face-down positioning, without ILM peeling can achieves excellent anatomical closure and visual acuity improvement. It was not only decreased and avoided of the risk of macular surgery, but also offered shorter operation time with more rapid postoperative recovery.

Key words: Macular hole , Internal limiting membrane, Gas