Prevention of visual field defects after macular hole surgery

Abstract

Background/aim-The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the eVect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. Methods-102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. Results-In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The diVerence in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. Conclusion-The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to diVer from eyes in which a complete posterior vitreous detachment has been eVected during surgery.

Intravitreal Expansile Gas in the Treatment of Early Macular Hole: Reappraisal

“…Cataract formation is the most frequent complication associated with vitrectomy [9,10]. Other reported complications include retinal pigment epithelium (RPE) alteration, cystoid macular edema (CME), retinal detachment (RD), visual field defects and endophthalmitis [11,12,13,14,15]. Persistence and reopening of the hole may also occur.…”

Intraocular Fluid-Air Exchange Reduces Retinal Ganglion Cell Activity

“…[3, 5, 6, 11, 12,14,15,16,17,18]]. Visual field defects may be induced by either damaging the optic nerve fiber layers or the underlying ganglion cells.…”

“…Visual field defects are a serious complication that may occur after vitreous surgery [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. After the first report of this unwanted symptom by Melberg and Thomas in 1995 [11], much work has been done to find out its causes.…”

“…More detailed histological analysis revealed that not only ganglion cells but also inner retinal structures and the optic disc have been damaged and that decreasing the pressure of infused air also decreases the risk of retinal damage [5, 6, 16, 18]. Another prevention of airflow-induced retinal damage is limited cortical vitreous removal [3]. However, there is the potential risk of retinal detachment due to incomplete vitrectomy.…”

Central and Paracentral Visual Field Defects and Driving Abilities

“…Iatrogenic causes of PCS have been reported most frequently as a consequence of ophthalmological surgery (laser photocoagulation, optic nerve sheet fenestration, PRK/LASIK refractive surgery, retinotomy and vitrectomy) [6, 19, 20, 23, 26, 27, 34, 46, 47, 80, 119, 136, 147, 151,154,155,156, 166, 190, 203]. Other procedures associated with iatrogenic VF loss include radiation and ENT surgery of the sinuses, neuro- and cardiovascular surgery [42, 87, 103, 108, 123, 137, 153, 162, 183, 188, 200].…”