Retinal sensitivity and fixation changes 1 year after triamcinolone acetonide assisted internal limiting membrane peeling for macular hole surgery – a MP‐1 microperimetric study

Abstract

Purpose: To evaluate microperimetric changes 1 year after macular hole surgery with triamcinolone acetonide assisted internal limiting membrane (ILM) peeling. Methods: Twenty-two eyes of 22 patients with stage 3 and 4 idiopathic macular holes of <6 months' duration underwent vitrectomy with triamcinolone acetonide assisted ILM peeling. Best corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution), and central retinal sensitivity were documented before and 1, 3, 6, and 12 months after surgery. Macular sensitivity (mean sensitivity in decibels-dB), and stability and location of fixation (preferred retinal locus) were determined using MP-1 microperimetry (Nidek). The MP-1 microperimetry sensitivity map was overlaid onto infrared images recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the fixation location before surgery. Anatomical success was evaluated with optical coherence tomography (OCT). Optical coherence tomography scans were recorded on an OCT 3000 scanner. Results: Anatomical success was achieved in all 22 eyes. All patients completed 1 year follow-up. No recurrence of macular hole was seen in any patients in the follow-up period. The mean BCVA improved from 0.75 ± 0.2 before surgery to 0.31 ± 0.1 log-MAR at the last visit (p < 0.001). Mean sensitivity improved from 3.7 ± 0.6 to 5.3 ± 1.0 dB at the last visit (p < 0.001). Before surgery, the preferred retinal locus was located on the margin of the hole in all, in 18 eyes on its upper part and in four eyes to the side or on its lower part. Preoperatively, 12 eyes were stable and 10 were relatively unstable, but 12 month after surgery, fixation stability had improved, and 20 eyes were stable and two were relatively unstable. Conclusions: MP-1 microperimetry sensitivity map overlaid onto an infrared image using dedicated MP-1 software can be used successfully to evaluate fixation location in patients with a macular hole before surgery. With microperimetry findings, we can also measure functional macular changes more precisely than using BCVA alone after mac-ular hole surgery. Our results also showed that retinal sensitivity and fixation properties were improved after vitrectomy with triamcinolone acetonide assisted ILM peeling in patients with idiopathic macular hole.

Macular Abnormality after Successful Surgery for Idiopathic Macular Hole Assessed Using Optical Coherence Tomography

“…Ozdemir et al [7] have also shown retinal sensitivity and fixation changes seen one year after ILM peeling for macular hole surgery using MP-1 micro perimetric study. Study showed postoperatively, there was a shift in the position of fixation point.…”

“…This comprehensive evidence by Pichi et al [1] appears to suggest that ILM peeling is traumatic and may have acute effects on nerve fiber layer. Focal ERG and micro perimetry studies suggest the role of Muller cell damage, reduced retinal sensitivity and incidence of micro-scotomas [5][6][7].…”

“…After the introduction of ILM peeling, the success rate of surgical management of macular hole has improved tremendously. Several studies have shown that internal limiting membrane (ILM) peeling in macular hole surgery causes changes in the macular thickness and decrease in retinal sensitivity [1][2][3][4][5][6][7][8][9][10].…”

Structural and functional characteristics of vitrectomized eyes

“…Вестник офтальмологии 6,2016 ложили, что основным источником аберраций яв-ляются изменения формы роговицы, а отсутствие СТ не влияет на аберрации. Выявлено, что наложе-ние швов в области склеральных портов приводит к возникновению роговичного астигматизма, за-трагивающего как переднюю, так и заднюю по-верхность роговицы.…”

“…Однако, не-смотря на эффективность данного метода лечения, его применение может стать причиной ряда струк-турно-функциональных изменений различных отде-лов глазного яблока. В современной специальной литературе подробно освещены вопросы подобных нарушений заднего отрезка глаза после витрэктомии [5,6]. Однако указанные изменения, наблюдаемые в проекции пространства переднего отрезка глаза, из-учены недостаточно.…”