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Comparative evaluation of brilliant blue staining using whole blood versus conventional brilliant blue staining for internal limiting membrane peeling in macular hole surgery

Session Details

Session Title: Vitreoretinal Surgery II

Session Date/Time: Friday 12/09/2014 | 14:30-16:00

Paper Time: 14:38

Venue: Boulevard C

First Author: : S.Batta Arora INDIA

Co Author(s): :    N. Goel   G. Bhushan   S. Thirumalai   A. Seth   M. Thakar   B. Ghosh

Abstract Details

Purpose:

To evaluate the usefulness of autologous heparinized whole blood (WB) in preventing toxicity of brilliant blue (BB) dye and to compare the structural and functional outcome of use of WB with BB versus conventional BB assisted internal limiting membrane (ILM) peeling in macular hole (MH) surgery.

Setting:

Randomized controlled trial.

Methods:

Patients with stage 2-4 and size of MH <0.5 disc diameter, duration of symptoms <12 months, best corrected visual acuity (BCVA) > 0.3 logMAR and MH of idiopathic and traumatic etiology were included while those with significant lenticular opacities , atrophic retinal pigment epithelium (RPE) and associated choroidal rupture were excluded. Sixty eyes of 60 patients were randomly divided equally in two groups. Group A patients underwent MH surgery using autologous heparinized WB followed by BB dye for staining ILM while patients in Group B underwent conventional BB staining. Postoperatively patients were assessed clinically, their BCVA and contrast sensitivity (CS) on functional acuity contrast test (FACT) chart recorded. Fundus photograph and spectral domain optical coherence tomography (SD-OCT) was done at 3 weeks, 6 weeks, 16 weeks and 6 months. Parameters noted on SD-OCT were type of hole closure (type1 – without neurosensory defect or type 2 – with neurosensory defect), foveal configuration (foveoid, flattened, notched or thinning), central foveal thickness (CFT), outer foveal thickness (OFT) and inner segment/outer segment junction (IS/OS jn) continuity.

Results:

Postoperatively BCVA increased significantly in each group compared to preoperative value (p< 0.001 at 3, 6, 16 weeks and 6 months). Group A patients had a significantly higher BCVA as compared to Group B at all postoperative visits (p<0.001 at 3 and 6 weeks, 0.004 at 16 weeks and 0.04 at 6 months). CS in Group A was significantly higher at 3, 6 and 16 weeks (p=0.012, 0.004 and 0.005) compared to Group B. Sixty percent of the patients in each group had a type 1 closure on OCT while 40% had type 2 closure. Mean OFT increased significantly at 16 weeks (p<0.001) and 6 months (p<0.001) compared to 3 weeks in Group B. Group A had significantly higher OFT at 3 weeks (p=0.001) and 6 weeks (p<0.001) compared to Group B. IS/OS jn continuity was noted in a significantly higher number of patients in Group A in comparison to Group B at every postoperative visit (p=0.02, 0.002, 0.003 and 0.03 at 3, 6, 16 weeks and 6 months). Fifty percent of the patients in Group A and 83% in Group B had a foveoid foveal configuration while others had a notched, flattened or thinned fovea (p=0.01).

Conclusions:

WB acts as a mechanical barrier, prevents deposition of dye into the macular hole and its subretinal migration. It reduces toxicity of dye by preventing its direct contact with bare RPE and photoreceptor cells. Earlier and better visual rehabilitation with the use of WB could be attributed higher OFT in the early postoperative period and IS/OS continuity in greater number of patients in early as well as late postoperative period. In conventional MH surgery with BB, the gradual increase in OFT may imply retardation of outer segment turnover after MH closure while with the use of WB outer segment restoration appeared to occur as early as 3 weeks. A foveoid foveal configuration was noted more often in the conventional MH surgery with BB (p=0.01) but notching, flattening or thinning of fovea did not seem to affect the visual acuity.

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