97th DOG Annual Meeting 1999



E. Messmer, D. Dori, A. Eckmann, F. Meier, P. Bernasconi, A. Thölen

The result of surgery for macular holes varies with regard to patient selection and the surgical technique applied. We report on the results of a consecutive series, operated on in the years 1995 - 1998, with consistent criteria of patient selection and treatment. Included were eyes with macular < 400 m and a history of visual loss < than 3 months. The surgical technique comprised a complete pars plana victrectomy with induction of a posterior vitreous detachment nasal to the disc , peeling of the internal limiting membrane only in cases of a pre-existing contracted epiretinal membrane (10 cases) and a intraocular gas tamponade with 12.5% C3F8 or silicone oil. No adjuvans was used to induce closure of the macular hole. Post-operatively, all patients with gas tamponade had to maintain a prone position for 3-4 weeks. 50 eyes of 46 patients met the inclusion criteria and were re-examined for this study. The ratio of male : female was 12 : 34. The median f!ollow-up was 7.2 months. Intra- or post-operative retinal detachment was observed in 6 cases. In all instances, a complete re-attachment of the retina could be achieved with intraocular gas tamponade. Peripheral sector field defects were observed in 48 out of 50 cases (96 %). Median pre-operative distant visual acuity was 0.25, median near vision was 0.21. For the evaluation of the post-operative visual acuity, eyes with persisting macular holes (2 eyes) were excluded. Median post-operative distant visual acuity was 0.61, median near visual acuity was 0.58.

We conclude that in cases with small and recent macular holes good functional and anatomical results can be achieved without removal of internal limiting membrane in most cases and without the use of adjuvans, if a long-term intraocular tamponade with C3F 8 or silicone oil is used and a prone position over 3-4 weeks is maintained.

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