Treatment of idiopathic macular hole with silicone oil tamponade

Abstract

PurposeWe analyzed the anatomical and visual outcomes after surgical treatment of idiopathic macular holes with pars plana vitrectomy, internal limiting membrane (ILM) peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing.MethodsThis was a retrospective interventional study of 10 eyes in eight patients who underwent surgical treatment of idiopathic macular holes using pars plana vitrectomy, ILM peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing. The preoperative staging of macular holes and postoperative anatomic outcomes were assessed using spectral-domain optical coherence tomography.ResultsAll patients were women with a mean age of 66.86 ± 4.8 years. In two patients, bilateral macular holes were present and both eyes were operated on. Stage 2 macular hole was diagnosed in three eyes, three eyes had stage 3, and four eyes had stage 4 macular holes. Anatomical success and closure of the macular hole was achieved in nine eyes (90%) after one operation. In one eye, the macular hole was closed after reoperation. The preoperative mean best-corrected visual acuity (BCVA) was 0.15 decimal units (0.8 logMAR units). Until the end of the follow-up period, BCVA was 0.25 decimal units (0.6 logMAR units). Visual acuity was improved in seven patients (70%). In two patients (20%), visual acuity remained at the same level, and in one eye (10%), visual acuity decreased. Postoperatively, all patients reported a significant reduction of metamorphopsia.ConclusionInitial results after 20G pars plana vitrectomy with peeling of the ILM, use of dye (Brilliant Blue), and tamponade with silicone oil without postoperative posturing gave good anatomical and functional outcome in terms of visual acuity and reduction of metamorphopsia. Taking into account the age of the patients, this method, which does not require prolonged postoperative face-down posturing, was well tolerated by the patients. Because the anatomical and visual outcome as well as the rate of postoperative complications are comparable to those when gas is used as a tamponading agent, silicone oil tamponade can also be safely used as a first option in surgery of macular holes. However, a longer period of follow-up of the operated eyes, as well as a larger group of operated eyes, will be required to identify long-term outcomes of this surgical treatment.

Macular pucker formation after macular hole surgery with inverted internal limiting membrane flap technique and silicone oil tamponade

“…The use of silicone oil as a tamponade substance for the treatment of macular holes is reported to be equivalent to gas tamponade in terms of anatomical and visual function improvements, and with regard to complication frequency. 8 The use of silicone oil in our current case was performed in order to enable early social rehabilitation. However, injections of silicone oil can potentially cause pre-ILM cellular proliferation on the vitreous side.…”

In Vitro Biocompatibility of Silicone Oil Siluron Xtra® on Porcine Retina in a Perfusion Culture System

“…As verified in previous studies, the use of silicone oil has been successfully applied in the treatment of difficult retinal detachment, showing good anatomical results, improved vision and reduced metamorphopsia in patients [3,5,6]. …”

“…While most commonly gas is used as an endotamponade during standard vitrectomy surgery, silicone oils have shown good post-operative results in the treatment of persistent macular holes [3] and especially in more complicated procedures such as giant retinal tear [4] and patients with retinal detachment due to proliferative diabetic retinopathy [5] and proliferative vitreopathy [6]. Usually, air or expanding gases are used as an endotamponade for macular holes in vitrectomy surgery [7][8][9].…”

A Review of Surgical Outcomes and Advances for Macular Holes

“…Face-down posturing is not strictly necessary when using silicone oil [ 83 , 116 ], and heavy silicone oil only requires that the patient be lied flat [ 116 ]. Silicone oil is mainly used for patients who cannot tolerate face-down posturing (e.g., children) [ 121 ], for large MHs [ 21 ], for MHs that remain open after the first operation [ 122 ], for highly myopic MHs with retinal detachment, and for cases involving posterior staphyloma [ 117 ]. Studies have demonstrated that initial closure rates and visual outcomes are lower with silicone oil than with gas [ 111 , 123 – 126 ], mainly because of silicone oil's lower buoyant force [ 124 ], toxic effect on photoreceptor cells, and the cases that are chosen for silicone oil use [ 21 , 83 , 124 ].…”