Effect of Perifoveal Tissue Dissection in the Management of Acute Idiopathic Full-Thickness Macular Holes

Abstract

To evaluate the efficacy of perifoveal tissue dissection (PTD) on patients undergoing pars plana vitrectomy for idiopathic macular holes of less than 1-year's duration.Methods: Pars plana core vitrectomy was performed on 107 eyes of 104 consecutive patients with acute idiopathic macular holes. One cohort had routine PTD. In the other cohort, no attempt was made to strip preretinal tissue. Follow-up was longer than 6 months (follow-up range, 6 to 36 months).Results: Overall, 95 (89%) of all macular holes were closed. Visual acuity improved 2 lines or more of the Snellen letter chart in 91 eyes (85%). A postoperative vi-

Macular holes: vitreoretinal relationships and surgical approaches

“…22 Surgical techniques and outcomes have since improved, and many case series now report primary anatomical closure following conventional surgery in more than 90% of eyes with full-thickness macular holes. [3][4][5][6] Intraocular tamponade agents in macular hole surgery Intraocular tamponade following vitrectomy for macular holes is believed to facilitate reapposition of the rim of detached neurosensory retina and to provide an interface with the vitreous fluid component that serves as a template for a fibrin membrane and glial migration across the macular hole. It is also suggested that the tamponade agent might address intraretinal hydration by preventing subretinal recruitment of vitreous fluid through the hole.…”

“…In one nonrandomised comparative series of 107 eyes, an overall closure rate of 89% was achieved with visual acuity improving by 2 lines or more in 85% of eyes; ILM peel was associated with no statistically significant difference in closure rate or visual outcome. 5 While ILM peeling may improve the rate of anatomical closure, evidence suggests that it can result in an adverse effect on visual function. In one series, ILM peel resulted in anatomical closure in 100% of 29 eyes compared to 85.1% of 27 eyes without ILM peel.…”

“…Anatomical closure and stabilisation of visual acuity can be achieved in over 90% of cases, and visual improvement in over 70% of eyes. [3][4][5][6][7] Outcomes are expected to improve further as a result of modifications to the conventional surgical technique, including peeling of the inner limiting membrane (ILM), with or without vital staining. Variations in the use of intraocular gas tamponade agents and postoperative positioning regimens may enable more individuals to benefit, accelerate visual rehabilitation, and reduce complications.…”

Photoablation of inner limiting membrane and inner retinal layers using the Erbium:YAG‐laser: An in vitro study

“…This transparent layer is acellular, composed of collagen closely associated with glycoproteins, and only a few micrometers thick. Several studies have proven the efficiency of ILM-maculorhexis in the treatment of macular holes and epimacular proliferation [1][2][3][4][5]. Recently, ILMremoval has been recommended also for patients with diffuse diabetic macular edema [6,7].…”

“…Macular hole surgery always involves complete vitreous detachment from the ILM [1][2][3]. This provides the possibility of subsequent selective ILM laser ablation because under such conditions the ILM is not covered by another tissue layer but directly accessible by the laser light.…”