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Macular hole in myopic foveoschisis- factors for success or failure of surgery

Session Details

Session Title: Vitreoretinal Surgery IV

Session Date/Time: Friday 27/09/2013 | 16:30-18:00

Paper Time: 17:10

Venue: Hall 3 (Level 0)

First Author: S.Ilian BULGARIA

Co Author(s):    P. Vassileva              

Abstract Details

Purpose:

To review the surgical results of vitrectomy for macular holes (MH) associated with myopic foveoschisis (MF) and to assess which preoperative methods can be used as a prognostic tool for possibility of MH closure.

Setting:

University Eye Hospital “Prof. Pashev”, Sofia, Bulgaria

Methods:

Three eyes of three patients with MH associated with MF underwent vitrectomy, internal limiting membrane peeling, direct drainage through MH and silicone oil tamponade. Two of the patients already had unsuccessful previous surgery with gas tamponade 1 to 8 months ago. Standard preoperative examinations included: slit lamp based biomicroscopy, optical coherence tomography (OCT), ultrasound measurement of axial length (AL) of the eye and best corrected visual acuity (BCVA).

Results:

The MH closed in two eyes and the BCVA improved more than 3 lines in all three eyes. The MH size increased in a patient with AL of 32 mm, but central macular thickness (CMT) decreased significantly in all cases. All patients who were phakic developed cataracts for a period of 3 to 6 months after vitrectomy with silicone oil. Cataracts were removed simultaneously with the silicone and postoperative follow-up underwent uneventful.

Conclusions:

Although significant visual improvement occurs in highly myopic eyes with MH associated with MF, single surgery is usually not sufficient for best possible visual recovery. OCT is essential for establishing the diagnosis, but the combination with ultrasound measurement of AL gives more detailed prognosis. Despite vitrectomy followed by gas tamponade, is the standard treatment of MH, silicone oil as a measure for permanent long term tamponade gives better anatomical outcomes in cases with MF.

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