A new method of treating macular holes

Abstract

Purpose: To evaluate the effect of pars plana vitrectomy (PPV) combined with joining of the hole edges on the closure of full-thickness macular holes.

Methods: In a prospective consecutive clinical trial, standard PPV with internal limiting membrane (ILM) maculorhexis was performed in 25 eyes from 25 patients with stage 3 or 4 idiopathic macular holes (Group A). The retina was massaged gently around the hole from the periphery to the center in order to approximate the edges as closely as possible. The edges of the macular hole were then joined with forceps and gently pressed together. At the end of surgery, air was used for intravitreal tamponade. Patients were required to remain in a face-down position for 1 day postoperatively. For the comparison, a retrospective analysis of outcomes of surgical treatment of 27 eyes of 27 patients with stage 3 to 4 idiopathic macular hole (Group B), whose surgery included standard three-port PPV, followed with ILM peeling, was performed. The closed macular holes were categorized into two patterns based on optical coherence tomography: flat/closed and flat/open.

Results: The overall closure rate was 92+/-5.4% over a minimum follow-up period of 6 months in Group A, and 86+/-6.2% in Group B. Best-corrected visual acuity improved from 0.1+/-0.014 (ranged from 0.02 to 0.5) before surgery to 0.29+/-0.03 (ranged from 0.2 to 0.7) after surgery in Group A, and from 0.1+/-0.05 (ranged from 0.05 to 0.4) before surgery to 0.22+/-0.04 (ranged from 0.05 to 0.4) after surgery in Group B. No significant difference was found in absolute light sensitivity of macula, intraocular pressure, or lens opacification. A common postoperative complication in Group A was retinal pigment epitheliopathy, which developed in 18 cases (72%).

Conclusions: Mechanical joining and compression of the retinal edges during surgery for stage 3 or 4 idiopathic macular holes appears to yield a promising anatomic and functional result.