Pars plana vitrectomy with gas tamponade for lamellar macular holes.

Department of Ophthalmology, Kagoshima City Hospital, 20-17 Kajiya-cho, Kagoshima 892-8580, Japan.
American Journal of Ophthalmology (Impact Factor: 4.02). 01/2006; 140(6):1154-1155. DOI: 10.1016/j.ajo.2005.07.022
Source: PubMed

ABSTRACT To report anatomic and visual improvement after pars plana vitrectomy with gas tamponade for a lamellar macular hole with poor central visual acuity.
Two interventional case reports.
Two patients with a lamellar macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherence tomography findings.
Vitrectomy with gas tamponade resulted in biomicroscopic, functional, and tomographic improvement in both patients for follow-up periods of 12 months.
Vitrectomy with gas tamponade may be an effective method for a lamellar macular hole with poor visual acuity.

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    ABSTRACT: To report macular structure on optical coherence tomography (OCT) after lamellar macular hole surgery and its relationship with visual outcome. Retrospective interventional case series; private practice setting. Twelve patients diagnosed with a lamellar hole who had undergone vitrectomy and who had OCT scanning before and after surgery and at least 6 months follow-up were included. Surgery consisted of 25 g vitrectomy, peeling of epiretinal and internal limiting membrane, fluid/air/gas exchange, and 2 weeks of face-down positioning. OCT showed an epiretinal membrane in all cases. After a mean follow-up of 16.7 months, VA improved by ≥2 lines in nine patients and remained stable in three. There was a complete closure of the lamellar hole in ten patients; in four a retinal pseudocyst was found during the healing process, resolving spontaneously in two and persisting in the other two after 8 and 9 months, respectively. Two patients developed a full-thickness macular hole that closed successfully after surgical repair. All patients had a VA ≥ 20/32 at the end of follow-up. Epiretinal membranes appear to have a role in the pathogenesis of lamellar macular holes. Vitrectomy is a useful technique to obtain closure of the lamellar hole and visual improvement. The presence of a retinal pseudocyst is a common feature during the healing process and is compatible with a favorable visual outcome. A full-thickness macular hole is a severe and not uncommon complication of this procedure.
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  • Retina (Philadelphia, Pa.) 04/2013; · 2.93 Impact Factor
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    ABSTRACT: The purpose of this study was to compare anatomic and visual changes in patients with lamellar macular hole undergoing pars plana vitrectomy with those in patients undergoing follow-up only. In this retrospective consecutive case series study, we evaluated two groups of eyes, comprising 19 eyes from 19 patients with lamellar macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and 21 eyes from 21 patients with lamellar macular hole who had follow-up only. Corrected distance visual acuity (CDVA, in logMAR) and optical coherence tomography findings, including measurements of maximum diameter of lamellar defect and foveal thickness, and whether the inner segment/outer segment band was intact or not were documented at initial and follow-up examinations. At initial examination, mean CDVA was 0.54 logMAR in the study group and 0.51 logMAR in the control group, and 0.33 logMAR and 0.55 logMAR, respectively, on final examination. In the study group, postoperative optical coherence tomography images were found to be normalized in ten patients (52.6%), improved in six (31.5%), unchanged in two (10.5%), and to have progressed to full-thickness macular hole in one (5.2%) in the intervention group, while all patients in the control group were found to have deteriorated within the follow-up period between March 2004 and June 2010. In patients with lamellar macular hole, combination treatment with pars plana vitrectomy and internal limiting membrane peeling appears to be effective, but further studies are required to establish new treatment modalities for patients who do not have a satisfactory outcome from treatment.
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