Long term results of surgery for idiopathic macular hole

Yıl 2019, , 370 - 374, 29.08.2019

Gülistan Oyur Leyla Hazar , Zeynep Alkın Mehmet Çakır

https://doi.org/10.35440/hutfd.534580

Öz

Background: To evaluate the success and complications of
internal limiting membrane peeling using triamcinolone acetonide with 23 Gauge
sutureless vitrectomy in the treatment of idiopathic macular hole.

Methods: The study enrolled 44 patients (49 eyes) who
performed 23 Gauge pars plana vitrectomy (PPV), internal limiting membrane
(ILM) peeling (used triamcinolone acetonide) and intraocular gas tamponade for
macular hole at 2006-2011 in Beyoğlu Eye Training and Research Hospital. Stage,
best corrected visual acuity (BCVA), symptom duration , postoperative
functional and anatomic success with optical coherens tomography were
evaluated.

Results: The mean age was 67±9.51. Twenty eight
(57.1%) were female and 21 (42.9%) were male. Twenty six (53.1%) of the holes
were stage 3, 20 (40.8%) were stage 4 and 3 (6.1%) were stage 2. The mean
duration of complaints of macular hole was 4.14 ±3.22 months (1-12 months). The
mean follow-up period was  13,81± 9,44
months (6-58 months). Anatomical success was achieved in 44 (89.8%) patients.
It was two or more lines of visual increase 51% (25 eyes) with snellen. It was
observed that preoperative BCVAs were better in patients with a history of
visual loss less than 6 months. There was no statistically significant
relationship between the last BCVA and hole diameter, hole stage, preoperative
BCVA and type of tamponade. Postoperatively, 33 patiens (67.3%) developed
cataract and 3 patiens (6.1%) hypotonia.

Conclusions: 23 G sutureless PPV with triamcinolone
acetonide assisted İLM peeling results in high anatomical and functional
success for  the treatment of idiopathic
macular hole. It was concluded that early surgery was the most important factor
affecting BCVA.

Anahtar Kelimeler

macular hole, triamcinolone acetonid

İdiopatik makula deliği cerrahisinde uzun dönem sonuçlarımız

Öz

Amaç: İdiopatik makula deliği cerrahisinde
23G sütürsuz vitrektomi ile triamsinolon asetonid kullanılarak iç limitan
membran soyulmasını değerlendirmek.

Materyal
ve Metot:
Beyoğlu Göz Eğitim ve Araştırma Hastanesi’nde 2006-2011 yıllarında, makula
deliği nedeniyle 23 Gauge pars plana vitrektomi (PPV) ile iç limitan membran
(İLM) (triamsinolon asetonid yardımıyla) soyulan ve göz içi gaz tamponadı
uygulanan 44 hastanın 49 gözüne ait veriler retrospektif olarak incelendi. Yaş,
cinsiyet, makula deliği evresi, en iyi düzeltilmiş görme keskinliği (GK),
semptom süresi, cerrahi sonrası fonksiyonel başarı ve optik kohorens tomografi
ile anatomik olarak değerlendirildi.

Bulgular: Ortalama yaşları 67 ±9,51 olan
hastaların 28’i kadın (%57,1) ve 21’i (%42,9) erkekti. Deliklerin 26 tanesi
(%53,1) evre 3, 20 tanesi (%40,8) evre 4, 3 tanesi ise (%6,1) evre 2 idi.
Hastaların şikayet süresi ortalama 4,14±3,22 ay (1-12 ay) idi. Ortalama 13,81±
9,44 ay (6-58 ay) takip edilen hastaların 44’ünde (%89,8) anatomik başarı elde
edildi. Snellen eşeline göre 2 veya daha fazla sıra görme artışı olan hasta
oranı %51 (25 göz) oldu. Görme kaybı 6 aydan daha az olan vakaların hem
preoperatif en iyi düzeltilmiş GK hem de postoperatif en iyi düzeltilmiş
GK’ları daha iyi saptandı. Son vizitteki en iyi düzeltilmiş GK ile deliğin
evresi, delik çapı, preoperatif en iyi düzeltilmiş GK ve tamponad çeşiti
arasında anlamlı ilişki bulunmadı. Ameliyat sonrası, 33 hastada (%67,3)
katarakt, 3 hastada (%6,1) hipotoni gelişti.

Sonuç: 23 G sütürsuz PPV ile triamsinolon
asetonid kullanılarak İLM soyulması uygulanan idiopatik makula deliği
tedavisinin yüksek anatomik ve fonksiyonel başarı ile sonuçlandığı görüldü.
Erken dönemde başvuru ve erken cerrahinin sonuç en iyi düzeltilmiş GK’yı
etkileyen en önemli faktör olduğu sonucuna varıldı.

Anahtar Kelimeler

makula deliği, triamsinolon asetonid, iç limitan membran

Kaynakça

• 1-Nischal K, Pearson A, editors. Clinical Ophtalmology, A Systematic Aproach. London, 2013.
• 2-Eckardt C. Transconjunctival sutureless 23 G vitrectomy. Retina 2005;25(2):208-211.
• 3-Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A et al. Initial experience using the Transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 2002;109(10):1814-20.
• 4-Lakhanpal RR, Humayun MS, de Juan E Jr, Lim JI, Chong LP, Chang TS et al. Outcomes of 140 consecutive cases of 25 Gauge transconjunctival surgery for posterior segment disease. Ophthalmology 2005;112(5):817-24.
• 5-Gupta OP, Weichel ED, Regillo CD, Fineman MS, Kaiser RS, Ho AC et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging 2007;38(4):270–275.
• 6-Tewari A, Shah GK, Fang A. Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy. Retina 2008 Feb;28(2):258-62.
• 7-Gass JD. Reapprasial of biomicroscopic classification of stages of development of macular hole. Am J Ophthalmol 1995;119(6):752-9.
• 8-Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 1991;109(5):654- 659.
• 9-Eckardt C, Eckardt U, Groos S, Luciano L, Reale E. Entfernung der Membrana limitans interna bei Makulalöchern. Klinische und morphologische Befunde. Ophthalmologe. 1997;94(8):545-551.
• 10-Christensen UC, Kroyer K, Sander B, Larsen M, Henning V, Villumsen J et al. Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial. Br J Ophthalmol. 2009;93(8):1005–1015.
• 11-Lois N, Burr J, Norrie J, Vale L, Cook J, McDonald A et al. Internal limiting membrane peeling versus no peeling for idiopathic full- thickness macular hole: a pragmatic randomised controlled trial. Invest Ophthalmol Vis Sci 2011;52(3):1586–1592.
• 12-Hasegawa Y, Hata Y, Mochizuki Y, Arita R, Kawahara S, Kita T, et al. T.Equivalent tamponade by room air as compared with SF(6) after macular hole surgery. Graefes Arch Clin Exp Ophthalmol 2009; 247(11):1455-9.
• 13-Rodrigues EB, Costa EF, Penha FM, Melo GB, Bottos J, Dib E et al. The use of vital dyes in ocular surgery. Surv Ophthalmol. 2009;54(5):576-617.
• 14-Schumann RG, Gandorfer A, Priglinger SG, Kampik A, Haritoglou C. Vital dyes for macular surgery: a comparative electron microscopy study of the internal limiting membrane. Retina. 2009; 29(5):669-76.
• 15-Kimura H, Kuroda S, Nagata M. Triamcinolone acetonide assisted peeling of the internal limiting membrane. Am J Ophthalmol 2004;137(1):172-173.
• 16-Tewari A, Almony A, Shah GK. Macular hole closure with triamcinolone-assisted internal limiting membrane peeling. Retina 2008;28(9):1276-9.
• 17-Nomoto H, Shiraga F, Yamaji H, Fukuda K, Baba T, Takasu I et al. Macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling: one-year results. Retina 2008; 28(3):427-32.
• 18-Şentürk F, Karaçorlu M, Özdemir H, Arf S. Triamsinolon Asetonid Yardımıyla İç Limitan Membran Soyulması Uygulanan İdiopatik Makula Deliği Olgularında Uzun Dönem Anatomik ve Görme Keskinliği Sonuçları. Ret-Vit 2008;16(3):226-229.
• 19-Tornambe PE, Poliner LS, Grote K. Macular hole surgery without face-down positioning. A pilot study. Retina 1997;17(3):179-185.
• 20-Eckardt C, Eckert T, Eckardt U, Porkert U, Gesser C Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning. Retina 2008; 28(8):1087-96.
• 21-Mittra RA, Kim JE, Han DP, Pollack JS. Sustained postoperative face-down positioning is unnecessary for successful macular hole surgery. Br J Ophthalmol 2009;93(5):664-6.
• 22- Evaluation of Ganglion Cell-Inner Plexiform Layer Thickness after Vitreoretinal Surgery with Internal Limiting Membrane Peeling in Cases with Idiopathic Macular Hole. Demirel S Abdullayev A. Yanık Ö. Batıoğlu F. Özmert E. Turk J Ophthalmol 2017; 47(3): 138-143
• 23-Kusuhara S, Negi A. Predicting visual outcomes following surgery for idiopathic macular hole. Ophthalmologica 2014;231(3):125-32.24-Ovalı T. Makula Deliği Cerrahisi. Ret-Vit 2007(Özel Sayı;)15:23-30.
• 25-Freeman W, Azen S, Kim J, el Haig W, Mishell DR, Bailey IL. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Arch Ophthalmol 1997;115(1):11-21.
• 26-Haritoglou C, Gass CA, Schaumberger M, Gandorfer A, Ulbig MW, Kampik A. Long-term follow-up after macular hole surgery with ILM peeling. Am J Ophthalmol 2002; 134(5):661-666.
• 27-Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G. Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina 2010; 30(1):107–11.
• 28-Lopez-Guajardo L, Pareja-Esteban J, Teus-Guezala MA. Oblique sclerotomy technique for prevention of incompetent wound closure in transconjunctival 25- gauge vitrectomy. Am J Ophthalmol 2006;141(6):1154-6.