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ILM closure of idiopathic macular hole

Session Details

Session Title: Vitreoretinal Surgery V

Session Date/Time: Sunday 20/09/2015 | 11:00-13:00

Paper Time: 12:20

Venue: Hermes

First Author: : M.Abdelkader EGYPT

Co Author(s): :    H. Moharam              

Abstract Details

PURPOSE:To determine the efficacy and safety of phacoemulsification with acrylic posterior chamber IOL and 23 gauge vitrectomy with Brilliant blue-assisted ILM peeling in idiopathic macular hole surgery with closure of the hole by an inverted flap of ILM.

Setting:

Ophthalmology depatment, El Menia university hospital, Egypt

Methods:

This prospective analysis study included 23 eyes of 23 patients with idiopathic macular hole treated by phacoemulsification with acrylic posterior chamber IOL and 23 gauge vitrectomy with Brilliant blue-assisted ILM peeling with closure of the hole by an inverted flap of ILM. Patients were examined in the first postoperative day, 1st week, two weeks and every month till the 12th month. Outcomes were evaluated in terms of improvement in the best corrected visual acuity, macular hole closure and complications. Macular hole closure was defined as the absence of a neurosensory defect over the fovea. A closed hole seen by slit-lamp biomicroscopy and confirmed on OCT was considered an anatomic success, whereas functional success was defined as an increase in visual acuity of at least 2 lines.

Results:

in 21 patients, the macular hole was closed with a single surgical procedure, while the macular hole persisted in two patients who undergone a reoperation and the hole closed in one patient and persisted in the other patient. These two patients had the longest duration of ocular symptoms (15-18 months). So, the total anatomic success was 95.7% (22 eyes) during the follow up period of 12 months. Overall, functional success was achieved in 19/23 eyes (82.6%). There were no intra-operative or postoperative vision threatening complications such as retinal tears, detachment or endophthalmitis, although a few petechial haemorrhages did occur while peeling the ILM. Two patients developed postoperative glaucoma which required medications for a short while; however, none of these required surgical intervention.

Conclusions:

In patients with iodiopathic macular hole, combining phacoemulsification with 23 gauge vitrectomy allows better visualization of the macula and allows complete shaving of the vitreous base. As the incidence of cataract after vitrectomy is very high, this combined technique safes time and cost and allows rapid patient rehabilitation and avoids the patient another operative interference. Using BBG allows good visualization of ILM and using ILM flap technique to close the iodiopathic macular hole is safe and effective procedure.

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