Vision-threatening Complications of Surgery for Full-thickness Macular Holes

Banker, Alay; Freeman, William R.; Kim, Jung V.; Munguia, David; Azen, Stanley P.; Kim, Jung Won; Lai, Michelle; Abrams, Gary W.; Dosick, Rabbi Wayne; Feldman, Sandy T.; Ochabski, Renata; Fine, Stuart L.; Bailey, Ian L.; Aaberg, Thomas M.; Berger, Brian B.; Blankenship, George W.; Brucker, Alexander J.; Bustros, Serge de; Yoshida, Akitoshi; Gilbert, Howard D.; Han, Dennis P.; Kokame, Gregg T.; McCuen, Brooks W.; Frambach, Donald A.; Olk, Joseph; Sipperley, Jack O.; Teeters, V.W.; Wood, William J.

doi:10.1016/s0161-6420(97)30118-3

Cited by 151 publications

(92 citation statements)

References 21 publications

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“…23,24 In our series, CMO occurred postoperatively in two patients (2.8%). In one of these cases, it was associated with an ERM and responded to peeling.…”

Section: Discussionmentioning

confidence: 53%

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Krishnan

Tossounis

Yang

2012

Eye

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Purpose To assess and compare the complications and long-term visual and anatomical outcomes of 20-and 23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair. Methods A retrospective, consecutive, interventional case series of 72 eyes with idiopathic macular holes were managed with 20-gauge PVT (n ¼ 36) or 23-gauge PVT (n ¼ 36). All patients underwent a posteriorchamber intra-ocular lens implantation and internal-limiting-membrane peel with the aid of either trypan blue or brilliant blue G 250 dyes. Results The macular hole closure rate was 97% with 20-gauge PVT and 100% with 23-gauge PVT. Mean follow-up was 24.06 ( ± 12.83) months with 20-gauge PVT and 17.47 ( ± 5.79) with 23-gauge PVT. Mean visual acuity improvement in LogMar was 0.41 ( ± 0.32) with 20-gauge PVT and 0.52 (±0.25) with 23-gauge PVT (P ¼ 0.135). The incidence of retinal breaks was higher with the 20-gauge PVT compared with the 23-gauge PVT, occurring in 13 (36.1%) and 4 (11.1%) cases, respectively (P ¼ 0.025). There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day 1, was significantly higher with 20-gauge PVT at 24.77 (±12.68) mm Hg compared with 17.20 (±6.95) mm Hg in 23-gauge PVT (P ¼ 0.0028). Operating times were longer in 20-gauge PVT at 89.36 ( ± 15.26) min compared with the 23-gauge PVT at 79.33 ( ± 23.82) min (P ¼ 0.04). Conclusion The 20-gauge PVT compared with 23-gauge PVT for macular hole repair is a slightly longer procedure and was associated with an increased incidence of retinal breaks and short-term elevated IOP. Both techniques have comparable visual and anatomical outcomes, but the 23-gauge PVT has advantages with regard to safety profile and operating time.

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“…23,24 In our series, CMO occurred postoperatively in two patients (2.8%). In one of these cases, it was associated with an ERM and responded to peeling.…”

Section: Discussionmentioning

confidence: 53%

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Krishnan

Tossounis

Yang

2012

Eye

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“…Other groups describe a similar beneficial outcome, but cases of possible toxic effects of ICG to the retinal pigment epithelium (RPE), eventually caused by the photodynamic properties of ICG, have been described [7]. Similar changes to the RPE have been described in macular hole surgery without the use of ICG, and have been attributed to a phototoxic effect during surgery [3]. This risk might be controllable by limited light exposure during surgery.…”

Section: Resultsmentioning

confidence: 93%

“…Attempts to peel the ILM implies the risk of traumatizing adjacent retinal tissue. Additionally, prolonged surgery duration due to difficulty of ILM identification may be responsible for phototoxic damage to the retinal pigment epithelium, which has been described by some authors [3].…”

Section: Introductionmentioning

confidence: 98%

Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery – a follow-up study

Weinberger

Schlossmacher

Dahlke

et al. 2002

Graefe's Arch Clin Exp Ophthalmol

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Background: Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of the ILM is an obstacle for successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. Patients and methods: Eighteen eyes with macular holes stages 2-4 were included. Intraoperatively, the ILM was stained with three drops of 1:9-diluted ICG. After 1 min incubation, the vitreous cavity was rinsed with Ringer's lactate solution, and the ILM was peeled. Autologous thrombocytes were applied to the macular hole and the eye was endotamponaded with 20% SF-6 gas.Preoperatively, 6 weeks postoperatively, and in 3-month intervals thereafter, visual acuity, fundus photographs, scanning laser ophthalmoscope imaging, and Humphrey 24-2 static perimetry was performed. Results: Intraoperatively, the ILM could be nicely visualized by ICG, which allowed easier and less traumatic peeling. At 6 weeks follow-up, visual acuity had improved in 14 of 18 patients, and the macular hole was closed 6 weeks after surgery. Scanning laser imaging revealed a strong signal. During prolonged follow-up, visual acuity declined due to cataract formation. Conclusion: ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We observed no negative effects on retinal function, but patients should be followed.Graefe's Arch Clin Exp Ophthalmol

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“…In both cases the macular hole remained closed. Retinal detachments have earlier been reported in up to 11-14% after macular hole surgery and usually secondary to peripheral retinal breaks (Park et al 1995;Banker et al 1997). The reason for the development of proliferative vitreoretinopathy in two eyes is unclear, but earlier described (Tornambe et al 1997).…”

Section: Discussionmentioning

confidence: 99%

Macular hole surgery without routine membrane excision or use of adjuvants

Byhr

Lindblom

2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To present results of macular hole surgery without adjunctive treatment or routine membrane dissection, but with a long duration tamponade. Methods: Fifty-one consecutive eyes underwent surgery with vitrectomy. Membrane peeling was performed only when traction was obvious. Pure perfluoropropane gas was injected as a tamponade followed by prone positioning for two weeks. All eyes were examined with scanning laser ophthalmoscopy (SLO) before and after surgery. Results: The macular hole was closed successfully in 48 eyes (94%) after one procedure. Visual acuity improved to 0.50 or more in 18 eyes (35%). Improvement of two or more lines was achieved in 35 eyes (69%). Two eyes developed retinal detachments and two eyes showed post-operative visual field defects previously reported after macular hole surgery. Conclusion: In this series the results and complication rates compare favourably with other reports of macular hole surgery. However, in contrast to many previous studies, membrane peeling was not done. The extent and long duration of the gas tamponade was thought to be important for the surgical success.

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Vision-threatening Complications of Surgery for Full-thickness Macular Holes

Cited by 151 publications

References 21 publications

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery – a follow-up study

Macular hole surgery without routine membrane excision or use of adjuvants

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