Macular hole surgery with inner limiting membrane peeling, endodrainage, and heavy silicone oil tamponade

Abstract

Purpose: To evaluate the anatomical and functional outcomes in macular hole (MH) patients who underwent vitrectomy with inner limiting membrane (ILM) peeling, endodrainage, and heavy silicone oil (HSO) endotamponade.

Design: A retrospective case series with 54 consecutive eyes from 53 patients with idiopathic stage 3 or 4 MHs.

Methods: Surgery with infracyanine green-assisted ILM peeling and endodrainage was performed. Patients who were phakic underwent a simultaneous phacoemulsification. At the end of the operation, a HSO tamponade was used in all cases. The patient maintained a face-up position for 24 hours postoperatively. The HSO was removed two to three months after initial surgery. Optical coherence tomography was performed preoperatively and postoperatively to determine the MH stage and the anatomical closure rate.

Results: The mean follow-up time was 6.6 months (range, 3.6 to 18.2 months). The overall median duration between the first symptoms and the surgery was four months (range, two to 37 months). The overall anatomical closure success rate after one surgery was 100%. The median preoperative visual acuity (VA) was 20/200 (range, 20/40 to 20/600) and increased to 20/50 (range, 20/20 to 20/300) postoperatively. The median increase in VA was five lines (mean, 4.8 lines; range, -3 to 12 lines). Of all 54 eyes, 30 (55 %) eyes had a final VA of 20/50 or better.

Conclusions: These findings indicate that surgery for MH with ILM peeling, endodrainage, and HSO endotamponade appears to induce a high incidence of anatomical closure with good visual outcome.