Macular Hole Surgery With 23-Gauge Vitrectomy

Zunaina Embong

Purpose: To report the outcomes of macular hole and complications related to 23-gauge vitrectomy in macular hole surgery

Methods: Retrospective review of 25 patients with a diagnosis of stage IV macular hole at Westmead Hospital between May 2006 and December 2007. All patients underwent 23-gauge vitrectomy, membrane peeling and gas tamponade. Main outcome measures were post-operative visual acuity, intra-ocular pressure and complications related to 23-gauge vitrectomy.

Results: Twenty-five eyes were included in the study. At 6 months post vitrectomy, the macular hole was closed in 12 eyes (48%), the hole was reopened in 9 eyes (36%) and the hole was not closed in 4 eyes (16%). Improvement of visual acuity from baseline was 66% in hole-closed at 6 months post surgery. Mean intra ocular pressure at day 1, day 7, one-month, 3-month and 6-month post-operatively was 16.1mmHg, 19.6mmHg, 17.8mmHg, 16.1mmHg and 15.2mmHg, respectively. Intra-operative and post-operative complications related to 23-gauge vitrectomy include leaking sclerotomy (4 eyes), cannula dislodge (1 eye), conversion to 20-gauge instrumentation (1 eye), subconjunctiva gas (2 eyes) and hypotony (3 eyes). There was no case of endophthalmitis and none of the operated eyes developed port related retinal tear.

Conclusion: Variable outcomes of macular hole post surgery and post-operatively hole closed showed improvement of visual acuity. A 23-gauge transconjunctiva pars plana vitrectomy is a safe procedure for macular hole surgery.