Surgical Management of Macular Hole at 2 Years of Follow-Up

Abstract

Purpose: To determine prognostic factors, anatomic success rate and safety of sutureless pars plana vitrectomy and vitreous base removal associated to internal limiting membrane (ILM) peeling, C3F8 injection and 1-day facedown postoperative positioning to manage idiopathic macular holes (MHs) at 2 years follow-up.Methods: Forty-six eyes with an idiopathic MH underwent pars plana vitrectomy, ILM peeling after Brilliant Blue 0.05 mg/ml staining, and gas tamponade. Patients remained facedown for 1 day postoperatively. Follow-up included measurement of best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at 1 and 7 days and 1, 6, 12, and 24 months postoperatively. If the MHs were not anatomically closed by 1 month, another procedure was performed.Results: Primary and final anatomical closure rate were 91.3% and 97.8%, respectively. Mean BCVA improvement (logarithm of the minimum angle of resolution, LogMAR) was 0.34. No late MH reopening occurred, no surgery-related or ocular dye-related complications developed. The BCVA was less likely to improve in MHs with longer symptomatic periods or larger internal diameters. Conclusion:Pars plana vitrectomy combined with vitreous base removal and ILM peeling using Brilliant Blue 0.05% associated to C3F8 injection and 1-day facedown postoperative positioning for idiopathic MHs is a safe surgical approach, achieving a MH closure rate of 91.3% after one procedure and 97.8% after a second one. Long symptoms duration and larger inner MH diameter are associated with poor BCVA.Keywords: Chromovitrectomy; Brilliant Blue; Macular hole; Vital dyes; Vitrectomy Summary StatementSutureless pars plana vitrectomy associated to posterior hyaloid detachment, internal limiting membrane peeling guided by brilliant blue, staining vitreous base removal, C3F8 injection and 1-day facedown postoperative positioning is a safe and effective surgical technique for management of macular holes.