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A comparative study of vitrectomy with or without internal limiting membrane (ILM )peeling in diabetic macular holes (DMH)

Session Details

Session Title: Vascular Diseases & Anterior/posterior segment surgery

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:20

Venue: Hall 3 (Level 0)

First Author: A.Shaarawy EGYPT

Co Author(s):    A. Bessa   M. Lolah   -. -   -. -     

Abstract Details

Purpose:

The purpose of the study was to clarify if ILM peeling during vitrectomy for diabetic macular hole can improve the visual and anatomical result of the diabetic macular hole

Setting:

A prospective double blind study was conducted on 20 eyes with diabetic macular hole divided blindly into 2 equal groups .Both groups were managed by 23 gauge vitrectomy.The first group was managed without ILM peeling the second group was managed in addition by ILM peeling

Methods:

Group I was managed by 23 gauge vitrectomy with peeling of posterior haloid using intravitreal triamicinolone followed by air/fluid exchange and tamponade by air or non expansile Sulfur hexafluoride gas.In the second group in addition,the ILM was stained by High density Trypan blue (MONOBLUE Naf X Arcadophta)France .The ILM was removed bimanually using Tnao Scraper and ILM peeling forceps.All eyes were followed up for 6 months following surgery.The X2-test and the Fisher's exact test(FET)were as a test of significance for comparison.

Results:

Anatomical closure of DMH was achieved in 60% of groupI and 80% of groupII.Visual Improvement of 2 lines or more was achieved in 40% of eyes in group I and 50% of groupII.Vision Remained the same in both groups in 40% of eyes.Vision became worse of 2 lines or more in 20% of eyes in group I and 10% of eyes in group II .Surgery was complicated by rhegmatogenous retinal detachment in one eye in group I,postoperative retinal thinning and atrophy on OCT in 3 eyes in group1 and 4 eyes in group II .Air was used as retinal tamponade in 2 eyes in groupI and 8 eyes in groupII.SF6 was used as retinal tamponade in 8 eyes in group I and in 2 eyes in groupII.There was no statistical difference between both groups as regard theses variables

Conclusions:

Vit with ILM peeling can result in anatomical closure of DMH and visual improvement. ILM peeling in DMH is mandatory for better anatomical and visual results although not statistically significant due to small size of sample studied. Bimanual dissection of ILM is essential to peel it in DMH with thin atrophic macula with long standing traction.

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