Pars plana vitrectomy with silicone oil tamponade for primary and secondary macular hole closure: Is it still a useful procedure?

Pieczyński, Janusz; Kuklo, Patrycja; Grzybowski, Andrzej

doi:10.1177/1120672117752423

Cited by 7 publications

(7 citation statements)

References 50 publications

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“…However, the operation procedure is complicated which may increase the risk of infection. Rao X reported that 89% patients achieved anatomic success after the outpatient inflating gas-fluid exchange by two needles for open macular hole after primary vitrectomy [ 15 , 16 ]. Additional intravitreal inflating gas injection can achieve complete macular hole closure for unsealed macular hole ≤700 µm [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole

Lin

Xia

et al. 2022

Journal of Ophthalmology

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Aim. To report the treatment of 7 cases of unsealed hole after macular hole surgery with air-fluid exchange. Methods. Retrospective case series. We collected 7 eyes of 7 patients with unsealed hole an unsealed hole about 2 weeks after macular hole surgery (23G vitrectomy with internal limiting membrane peeling with sterilizing air tamponade) in our hospital from February 2018 to December 2018. All patients underwent “air-liquid exchange by free hand and one needle.” The prone position was taken one week after operation. The macular holes before and after operation were examined by frequency-domain optical coherence tomography (SD-OCT). Results. The size of the macular hole before vitrectomy was 481 ± 156 μm (range: 281–609 μm). Two weeks after vitrectomy (before air and liquid exchange), the size of the macular hole was 295 ± 92 μm (range: 210–421 μm). All macular holes were closed within 7–14 days after air-liquid exchange. There was no complaint of discomfort among these patients. Conclusion. From this preliminary study, air-liquid exchange by free hand and one needle seems to be safe and effective in the treatment for patients with unsealed and tiny macular hole after vitrectomy as the lack of long effective gas in China. However, the exact efficacy and safety need further large case studies.

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Section: Discussionmentioning

confidence: 99%

Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole

Lin

Xia

et al. 2022

Journal of Ophthalmology

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“…It is unknown whether a further ILM peeling extension passed the vascular arcades alone, or in conjunction with A-ILM techniques, may give any adjunctive benefit. It should also be noticed that many re-operation techniques including further bubbling, 10 silicone oil tamponade, 11 ILM peeling enlargement, macular detachment 13 and full-thickness retinal transplantation 14 have been proposed, while we only compared A-ILM versus what we routinely used: ILM peeling enlargement and further tamponade. Pitfalls of this study should also mention the relatively short follow-up and limited series dimension.…”

Section: Discussionmentioning

confidence: 99%

“…Proposed treatment options for recurrent idiopathic macular holes (r-IMHs) vary greatly from the simple introduction of a novel gas bubble 10 to silicone oil tamponade, 11 ILM peeling enlargement, use of ILM flaps, autologous internal limiting membrane (ILM) transplantation, 12 induction of macular detachment 13 and autologous full-thickness retinal transplantation. 14…”

Section: Introductionmentioning

confidence: 99%

Autologous internal limiting membrane transplant for recurrent idiopathic macular holes

Rossi

Trillo

Ripandelli

2020

European Journal of Ophthalmology

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Purpose: To report a series of recurrent idiopathic macular holes treated by means of a free autologous internal limiting membrane flap and compare visual and anatomic results to a control group undergoing further internal limiting membrane peeling and novel gas tamponade. Methods: Retrospective surgical series of 15 consecutive patients receiving autologous internal limiting membrane flap compared to 14 patients operated on for internal limiting membrane peeling enlargement. Autologous internal limiting membrane flap was created after brilliant blue G staining, internal limiting membrane lifting, perfluorocarbon bubble injection and creation of a wide internal limiting membrane free flap translocated underneath perfluorocarbon liquid, to the macular hole bed. Both groups were tamponated with 20% SF6 and positioned face down for 4 h a day for 3 days. Results: Macular hole closed in 14/15 (93.3%) patients of the autologous internal limiting membrane group and 9/14 (64.2%) controls (p < 0.05). Visual acuity increased from 0.05 ± 0.03 to 0.23 ± 0.13 Snellen in the autologous internal limiting membrane group and from 0.05 ± 0.03 to 0.14 ± 0.10 Snellen of controls (p < 0.05 for both). Vision of the autologous internal limiting membrane group improved more than controls at 1 month (p = 0.043) and 3 months (p = 0.045). Inner segment/outer segment interruption at 3 months was smaller in the autologous internal limiting membrane group than controls, reducing from 1230 ± 288 µm at baseline to 611 ± 245 and 547 ± 204 µm at 3 months versus 1196 ± 362, 745 ± 222 and 705 ± 223 µm, respectively (p < 0.05). Conclusion: Autologous internal limiting membrane flap can effectively close recurrent idiopathic macular holes with a higher closure rate, smaller residual inner segment/outer segment line interruption and higher visual acuity at 3 months than previous standard of care.

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“…Known adverse effects include inflammation [35] and silicone emulsification [33,35], elevated IOP [33] and potential development of secondary glaucoma [35] and accelerated nuclear sclerosis [36] with cataract formation [33]. Pieczynski et al meta-analysis on the current silicone oil tamponade found good efficacy for primary and recurrent MH closure, with the method being similar for complications with gas tamponade [38], however requiring the second silicone extraction surgery [39] and indicated it as an alternative after gas tamponade [39]. Functional outcomes after MH closure surgery are dependent on the restoration of the foveal structure, particularly regarding the outer retinal segment [46].…”

Section: Figure 3 -Comparison Of Pre-op Va and Va At One-year Post-op...mentioning

confidence: 99%

Postoperative retinal microstructure and functional outcome after inverted-flap technique associated with silicone oil tamponade in macular hole surgery

Dragosloveanu

Zamfiroiu-Avidis²,

Dragosloveanu³

et al. 2022

Rom J Morphol Embryol

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Purpose: Our retrospective study on 27 patients with a large mean macular hole diameter (MH-D) of 480.08±78.62 μm evaluates the usefulness of combining the current internal limiting membrane (ILM) inverted-flap surgical technique with silicone oil tamponade, which has been associated with the classical technique of ILM peeling. Results: Functional results: mean visual acuity (VA) improved to 0.89±0.11 logMar (logarithm of the minimum angle of resolution, at one month), 0.67±0.03 logMar (at three months), 0.52±0.04 logMar (at six months), 0.42±0.15 logMar (at one year) postoperative (final VA), with statistical linkage between preoperative VA and final VA (two-sample t-test, p=0.007), mean MH-D and final VA (regression analysis, p=0.003). We compared the results by MH size (Group A ≤400 μm -eight eyes and Group B >400 μm -19 eyes), finding statistical variance (Bonett & Levene methods). Group A presented a final VA of 0.21±0.12 logMar, while Group B had 0.51±0.17 logMar. Successful closure was noted in 25 (92.59%) cases, with Group A having complete closure and external limiting membrane (ELM) restoration with ellipsoid zone (EZ) regeneration in six cases. Group B had successful closure in 17 (89.47%) cases with ELM restoration in 16 cases and EZ regeneration in seven (38.88%) cases, with reintervention in two cases. Restoration of the ELM was correlated [Pearson's correlation coefficient (PCC) of 0.999, p=0.022] with successful closure, with overall restoration obtained in 24 (88.88%) cases and EZ regeneration in 13 (48.14%) cases. Conclusions: ILM inverted-flap technique with silicone oil tamponade had favorable functional and anatomical outcomes. ELM restoration was associated with successful MH closure.

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Pars plana vitrectomy with silicone oil tamponade for primary and secondary macular hole closure: Is it still a useful procedure?

Cited by 7 publications

References 50 publications

Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole

Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole

Autologous internal limiting membrane transplant for recurrent idiopathic macular holes

Postoperative retinal microstructure and functional outcome after inverted-flap technique associated with silicone oil tamponade in macular hole surgery

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