![]() Idiopathic macular holes occur almost exclusively in older patients, who are least able to maintain face-down positioning requirements because of increased incidence of cervical and lower back ailments. "We needed to demonstrate that our no-face-down approach did not increase IOP." Older patients benefit "Face-down positioning reduces the anterior displacement of the lens-iris diaphragm that often elevates IOP in the presence of gas endotamponade," says Dr. Mean postoperative intraocular pressure (IOP) was 15 mm Hg and 16 mm Hg on postoperative days one, seven and 30, respectively, and did not differ significantly from the mean preoperative IOP of 16 mm Hg.The incidence of postoperative retinal detachment or macular hole reopening was 0 percent. Over a mean follow-up of 216 days, 79 percent of phakic eyes eventually proceeded to cataract surgery. The mean interval from macular hole repair to cataract surgery was 207 days. There were no cases of gas bubble-induced cataract that required prompt cataract surgery.Of the 61 eyes that completed at least three months' follow-up, 53 eyes achieved 20/50 BCVA or better. Overall, 56 of 68 eyes achieved best corrected visual acuity (BCVA) of 20/50 or better at last follow-up.The single-procedure macular hole closure rate was 100 percent (95 percent confidence interval was 95 to 100 percent) as observed by optical coherence tomography.In this study, all eyes completed one-month follow-up and 61 of 68 eyes completed the three-month follow-up.įindings, published online in the journal Ophthalmology in July 2013, include: "We considered the single-procedure macular hole closure rate, the mean postoperative best corrected visual acuity, the incidence of cataract and intraocular pressure to compare this surgical treatment with methods that use longer acting gas endotamponade, face-down positioning or both," says Dr. A posterior vitreous detachment was present in 20 eyes before surgery.At the time of surgery, 24 eyes were pseudophakic and 44 eyes were phakic.21 eyes had stage 2, 27 had stage 3, and 20 had stage 4 macular holes.3 patients had bilateral macular holes, and 9 were referred to Mayo for treatment of their recurrent macular holes.Of the 68 eyes studied, 48 were in women and 20 were in men. Broad ILM peeling, 20 percent SF6 gas and no face-down positioning were employed in all of the surgeries. Iezzi's team reviewed all idiopathic macular hole surgeries he performed at Mayo Clinic between March 2009 and December 2012. "Macular hole closure using limited face-down posturing has been reported previously with varying rates of success."ĭr. "This may place a significant burden on patients and even eliminates the surgical opportunity for some," says Raymond Iezzi Jr., M.D., with the Department of Ophthalmology at Mayo Clinic in Rochester, Minn. The assessment of corneal endothelium is also necessary, usually by means of a slit lamp, and sometimes with endothelial cell count.Currently, most surgeons employ face-down positioning for variable periods following macular hole repair surgery. ![]() Ultrasound or interferometry biometry: when a cataract surgery is considered, keratometric data becomes necessary and the measurement of the axis by means of type A ultrasound or laser is used to calculate the power of the intraocular lens that the patient will need.In some patients, it may be necessary to complete the study with this test in order to rule out other retinal diseases. A macular OCT to confirm the diagnosis, determine the size and shape of the macular hole, rule out a cystoid macular oedema and assess the status of the different retinal layers.It is also very important to rule out vitreous inflammation and examine the retina in depth. A macular study of the retina, paying special attention to the macula in order to determine the extent of the hole.A biomicroscopy under pupil dilation, with direct lighting and backlighting, in order to study the cornea, the anterior chamber, and the existence of a cataract, as well as to rule out any ocular inflammation.Distant and near vision, pupil examination and refraction.Personal history: drugs, trauma, systemic diseases and eye diseases. ![]() This is performed in an only procedure in order to avoid the need to perform a second intervention later in time. ![]() In patients who also suffer from a cataract, a combined surgery consisting in cataract extraction and macular hole surgery is recommended. If that’s the case, both problems would need to be treated.īefore solving the macular hole, we need to assess the degree of cataract of the patient. Determine whether any of the above-mentioned causes is responsible for the macular hole. ![]()
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