Visual Field Defects After Macular Hole Surgery

Boldt, H. Culver; Munden, Paul M.; Folk, J. C.; Mehaffey, Mary G.

doi:10.1097/00006982-199616060-00025

Cited by 4 publications

(6 citation statements)

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“…peripheral field defects [49][50][51][52][53][54][55][56][57][58] ; retinal tears (3%) 59 ; retinal detachments (RDs) (1.8%-14.0%) [59][60][61] ; retinal pigment epithelium damage or phototoxicity (1%-3%) 59,60,62,63 ; and glaucoma. 64 The incidence of adverse effects highlights the importance of randomized clinical trials (RCTs) that include observational controls and incorporate strict criteria for ensuring that particular medical centers involved use only surgeons who have a high level of surgical experience.…”

Section: Cme Course Available At Wwwarchophthalmolcommentioning

confidence: 99%

Surgery for Idiopathic Full-Thickness Macular Hole

Ezra¹

2004

Arch Ophthalmol

174

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Objectives: To determine the benefits of idiopathic fullthickness macular hole (FTMH) surgery compared with observation and to evaluate the use of autologous serum as an intraoperative adjunct.Methods: A randomized clinical trial was performed to evaluate the anatomic and visual benefits of FTMH surgery for lesions of 9 months or less symptom duration and visual acuity of 20/60 or less. We compared surgery with natural history and determined whether use of intraoperative adjunctive autologous serum improves the surgical outcome. Eyes were randomized to (1) observation, (2) vitrectomy, or (3) vitrectomy plus serum and were followed for 24 months to assess anatomic status and visual function.Results: In total, 185 eyes of 174 patients were enrolled.

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Section: Cme Course Available At Wwwarchophthalmolcommentioning

confidence: 99%

Surgery for Idiopathic Full-Thickness Macular Hole

Ezra¹

2004

Arch Ophthalmol

174

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“…Although a duration of up to 4 weeks of intraocular tamponade with a long acting gas and prone positioning was initially believed to be essential for improved MH closure rate, 10 similar successful outcomes have been achieved with much shorter periods, ranging from 2 weeks or less, [10][11][12][13]32,33,53 to no postoperative positioning at all. 38,39,54 Moreover, PPP may play a role in the development of postoperative IOP elevation 55 and visual field defects, 56 as well as retinal pigment epithelial damage, 37 the most common sight threatening postoperative complication in the Vitrectomy for Macular Hole Study. 16 Furthermore, PPP may be associated with ventilatory disturbances in some patients by decreasing the minute ventilatory volumes and increasing transcutaneous carbon dioxide tensions.…”

Section: The Elimination Of Ppp and Silicone Oil Tamponadementioning

confidence: 99%

Combined pars plana lensectomy/vitrectomy for idiopathic macular hole repair without postoperative prone positioning

Ghazi

Daccache

Knape

et al. 2008

DJO

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Purpose-The aim of this study is to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic macular hole (MH) without post-operative prone positioning (PPP).Materials and Methods-A retrospective chart review of 42 patients (47 eyes) with MH who underwent CPPLV was performed. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week. The main outcome measures included MH closure rate, best corrected post-operative Snellen visual acuity (BCVA), and procedure complications.Results-Anatomical closure was achieved in 44 eyes (93.6%). The average BCVA in these eyes improved from 20/203 at baseline to 20/91 post-operatively, with 28 (63.6%) having 20/40 or better. Twenty-eight (59.6%) of the 47 eyes had a BCVA of 20/40 or better post-operatively and 35 (74.5%) eyes improved by at least 2 Snellen lines. Post-operative retinal detachment (RD) was observed in 4 eyes (8.5%) and late reopening of the hole in 4 (9.1%).Discussion-The anatomical and visual outcomes and the RD rate of CPPLV with sulcus intraocular lens implantation without PPP are comparable to those of traditional MH surgery techniques. The main advantages include sparing the patient the inconvenience of PPP and eliminating the need for additional postvitrectomy cataract extraction procedure.

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“…[1][2][3][4][5][6] The exact mechanism causing the visual field defects after the surgery is still not com-pletely known, but it has been proposed that the defects are caused by inner retinal damage due to air-infusion stress, 7,8 prolonged gas tamponade, 2,4 or the removal of the posterior hyaloid. 2,3,5 More recently, another cause of inner retinal damage has been suggested to arise from indocyanine green (ICG), which is used when the internal limiting membrane is removed. 9 -13 These reports motivated us to hypothesize that the function of the inner retina may be extensively impaired after macular hole surgery, even though the patients may not report any subjective visual disturbances.…”

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confidence: 99%