25 Gauge Pars Plana Vitrectomy Results in Idiopathic Macular Holes

Abstract

Purpose: To evaluate the anatomical and functional efficacy, safety and complications of 25 gauge (G) sutureless pars plana vitrectomy (PPV) in idiopathic macular holes.
Material and Methods: Between March 2005 – May 2008, 30 eyes with 28 patients that had undergone 25 G PPV in our clinic were included in the study. Pre- and post-operative visual acuities, intraoperative and postoperative complications were noted, retrospectively.
Results: The mean age of the patients was 65 ± 10.68 (range 40 -84) years and 30 eyes of 18 females (64.2%) and 10 males (35.8%) were studied. 22 patients (73.3%) had grade 3, 6 patients (20%) had grade 4 and 2 patients (6.7%) had grade 2 macular holes. The mean pre- operative best corrected visual acuity (BCVA) of the patients were 0.12 ± 0.09 (logMAR 0.98±0.33, range 0.05 – 0.4). Survey of macular holes was 9.55 ± 8.97 months (1 – 24 months). The mean follow-up was 13.81 ± 9.44 (range 1-30) months and 29 of 30 eyes (96.6%) achieved anatomical success. BCVA was decreased statistically significant between pre- and post-operatively (p<0.05). Postoperative retina pigment epithelium (RPE) changes were seen in 9 (30%) eyes, cataract was seen in 8 (27.67%) eyes, hypotony was seen in 3 (10%) eyes and retinal detachment was seen in one (3.34%) eyes.
Conclusion: The 25 G sutureless vitrectomy technique is anatomically and functionally effective in idiopathic macular holes.

Keywords

• 25 G vitrectomy,Macular hole,Sutureless vitrectomy

İdiyopatik Makula Deliği Tedavisinde 25 Gauge Pars Plana Vitrektomi Sonuçlarımız

Abstract

Amaç: İdiyopatik makula deliği cerrahi tedavisinde uygulanan 25 gauge (G) pars plana vitrektomi (PPV) cerrahisinin anatomik ve fonksiyonel başarısını ve komplikasyonlarını değerlendirmek.
Gereç ve Yöntemler: Mart 2005 – Mayıs 2008 tarihleri arasında hastanemizde makula deliği nedeniyle vitreoretinal cerrahi geçiren 28 hastanın 30 gözüne ait veriler retrospektif olarak incelendi ve olgular anatomik ve fonksiyonel başarı ile görülen komplikasyonlar açısından değerlendirildi.
Bulgular: Yasları 40 ile 84 arasında değişen (ortalama 65 ± 10,68 yıl) olguların 18’i (%64,2) kadın ve 10’u (%35,8) erkekti. 22 olguda (%73,3) evre 3, 6 olguda (%20) evre 4, 2 olguda ise (%6,7) evre 2 makuler delik mevcut idi. Cerrahi öncesi en iyi düzeltilmiş görme keskinlikleri (EDGK) ortalama 0,12 ± 0,09 (logMAR 0,98 ± 0,33, 0,05 – 0,4 arası) olarak saptandı. Makula deliklerinin süresi ortalama 9,55 ± 8,97 ay idi. (1 – 24 ay) 25 G PPV cerrahisi sonrası ortalama 13,81 ± 9,44 ay (1-30 ay) takip edilen 30 gözün 29 ‘unda (%96,6) anatomik başarı elde edildi. Olguların cerrahi öncesi ve sonrası EDGK arasındaki fark istatistiksel olarak anlamlıydı (p<0,05). Ameliyat sonrası, 9 olguda (%30) retina pigment epiteli (RPE) değişiklikleri, 8 olguda (%26,67) katarakt, 3 olguda (%10) hipotoni ve 1 olguda (%3,34) retina dekolmanı gelişti.
Sonuç: İdiyopatik makula deliği cerrahi tedavisinde 25 G sütürsüz vitrektomi tekniği hem anatomik hem fonksiyonel iyileşme açısından etkili bulunmuştur.

Keywords

• 25 G vitrektomi,Makula deliği,Sütürsüz vitrektomi

References

1. 1. David B. Nelson, R. Lee Grantham, Dennis M. Marcus: Traumatic Giant Macular Hole. Retina 2001; 21:677-678.
2. 2. Morgan CM, Schatz H: Idiopathic macular holes. Am J Ophthalmol 1985; 99:437–444.
3. 3. Gass JDM: Idiopathic senile macular hole: Its early stages and pathogenesis. Arch Ophthalmol 1988; 106:629–639.
4. 4. Ryan SJ. Retina 5th ed. New York: Saunders 2013. Gaudric A, Tadayoni R. Macula Hole. Chapter 117, p.1969-75.
5. 5. Kanski JJ, Bowling B, editor. Oftamologia clínica. 7th ed. Rio de Janeiro: Elsevier; 2012. p. 629.
6. 6. Schepens CL. Fundus changes caused by alterations of the vitreous body. Am J Ophthalmol. 1955; 39:631.
7. 7. Reese AB, Jones IS, Cooper WC. Macular changes secondary to vitreous traction. Trans Am Ophthalmol Soc. 1966; 64:123.
8. 8. Worst JGF. Cisternal systems of the fully developed vitreous body in the young adult. Trans Ophthalmol Soc UK. 1977; 97:550–554.

9. 9. Gass JDM. Idiopathic senile macular hole: Its early stages and pathogenesis. Arch Ophthalmol. 1988; 106:629–639.
10. 10. Ibarra MS, Hermel M, Prenner JL, Hassan TS. Longer-term outcomes of transconjunctival sutureless 25 Gauge vitrectomy. Am J Ophthalmol. 2005; 139:831-836.
11. 11. Yanyali A, Celik E, Horozoglu F, Oner S, Nohutcu AF. 25Gauge transconjunctival sutureless pars plana vitrectomy. Eur J Ophthalmol. 2006; 16:141-147.
12. 12. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the Transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109:1814-20.
13. 13. Rizzo S, Genovesi-Ebert F, Murri S, et al. 25Gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol. 2006; 19:18 – 20.
14. 14. Chang CJ, Chang YH, Chiang SY, Lin LT. Comparison of clear corneal phacoemulsification combined with 25Gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases. J Cataract Refract Surg. 2005; 31:1198-207.
15. 15. Shimada H, Nakashizuka H, Mori R, Mizutani Y. Expanded indications for 25Gauge transconjunctival vitrectomy. Jpn J Ophthalmol. 2005; 49:397-401.
16. 16. Gass JD: Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol.1995;119:752–759.
17. 17. Ho AC, Guyer DR, Fine SL. Macular Hole. Surv Ophthalmol 1998; 42:393-416.
18. 18. The Eye Disease Case-Control Study Group. Risk factors for idiopathic macular holes. Am J Ophthalmol. 1994; 118:754-761.
19. 19. McCannel CA, Ensminger JL, Diehl NN, Hodge DN. Population-based incidence of macular holes. Ophthalmology. 2009;116:1366-139.
20. 20. Wendel RT, Patel AC, Kelly NE, et al. Vitreous surgery for macular holes. Ophthalmology 1993; 100:1671-1676.
21. 21. Kim JW, Freeman WR, Azen SP, et al. Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Am J Ophthalmol 1996; 121:605-614.
22. 22. Leonard RE, Smiddy WE, Flynn HW Jr, Feuer W. Long-term visual outcomes in patients with successful macular hole surgery. Ophthalmology 1997; 104:1648-1652.
23. 23. Hirata A, Yonemura N, HasumuraT, et al. Effect of infusion air pressure on visual field defects after macular hole surgery. Am J Ophthalmol 2000; 130:611-616.
24. 24. Park DW, Sipperley JO, Sneed SR, et al. Macular hole surgery with ILM peeling and intravitreous air. Ophthalmology 1999; 106:1392-1398.
25. 25. Haritoglou C, Gandorfer A, Gass CA, Schaumberger M, Ulbig MW, Kampik A. ICG- assisted peeling of the internal limitan membrane in macular hole surgery affects visual outcome: A clinicopathologic correlation. Am J Ophthalmol 2002; 134:836-841.
26. 26. Johnson RN, Gass JDM. Idiopathic macular holes. Ophthalmology 1988; 95:917- 924.
27. 27. Sulkes DJ, Smiddy WE, Flynn HW, et al. Outcomes of macular hole surgery in severely myopic eyes: A case control study. Am J Ophthalmol 2000; 130:335-339.
28. 28. Mester V, Kuhn F. Internal limitan membrane removal in the management of fullthickness macular holes. Am J Ophthalmol 2000;129:769-777.
29. 29. Banker AS, Freeman WR, Kim JW, et al. Vision threatening complications of surgery for full-thickness macular holes. Vitrectomy for Macular Hole Study Group. Ophthalmology 1997; 104:1442-1452.
30. 30. Park SS, Marcus DM, Duker JS, et al. Posterior segment complications after vitrectomy for macular hole. Ophthalmology 1995; 102:775-781.
31. 31. Freeman W, Azen S, Kim J, et al. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Arch Ophthalmol 1997; 115:11-21.
32. 32. Haritoglou C, Gass CA, Schaumberger M, et al. Long-term follow-up after macular hole surgery with ILM peeling. Am J Ophthalmol 2002; 134:661-666.
33. 33. Singh S, Byanju R, Pradhan S, Lamichhane G. Retrospective Study on Outcome of Macular Hole Surgery. Nepal J Ophthalmol. 2016; 8:139-143.