Remote functional and anatomical results of idiopathic macular hole surgery performed without postsurgical vitreous cavity tamponade

Abstract

   Purpose. To assess remote results of our method of macular hole (MH) surgery without postsurgical vitreous cavity tamponade.   Material and methods. 34 eyes of34 patients were operated for full-thickness MH 100 to 932 (558.5 ± 50.9) microns in diameter with no vitreous cavity tamponade. Before surgery, best corrected visual acuity (BCVA) was 0.02 to 0.25 (0.11±0.02). The operation included 3-port 25—27 G vitrectomy, separation of posterior hyaloid membrane, staining and removal of the internal limiting membrane (ILM) with subsequent ex­change of salt solution for air. The hole edges were passively (without touching the retina) pulled towards the center using an extrusion cannula through air supplied into the vitreous cavity under the pressure of 20—25 mm Hg. After that, 0.05 to 0.1 ml of platelet rich plasma (PRP) of the patient was applied to macular hole zone. In 2 minutes, a fibrin film was formed at the place of application which was pressed to the retina by injecting 0.5 ml of Perfluororganic Compound liquid (PFCL) into the vitreous cavity. PFCL was exposed for 3 minutes, whereupon it was passively aspirated. The operation was completed by air exchanged for salt solution. High specific weight of PFCL facilitated a tight adhe­sion of fibrin film to the retina. The follow-up period was 1 to 20 months (7.9±0.8 on average).   Results. After the surgery, complete closure of the macular hole was achieved in 32 of 34 cases (94.1%). No intraoperative or postoperative complications were observed. Postsurgical BCVA improved to 0.3—0,7(0.50 ± 0.05). At the initial stage of the study, a recurrence ofMH took place in two cases associated with partial mechanical displacement of the fibrin film by the cannula during PFCL removal.   Conclusions. The proposed method of macular hole surgery avoiding postoperative vitreous cavity tamponade with gas or another vitreous substitute is effective, speeds up the rehabilitation and may be used in routine clinical practice, especially in patients with the only seeing eye, those with a transparent lens, those who need to take a plane or rise at great heights soon after the surgery, as well as those at risk of increased IOP or unable to sustain a forced head position even for a short time span.