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Idiopathic Macular Holes, With Internal Limiting Membrane (ILM)-
Assisted Peeling, Anatomical and Visual Outcomes
Mamdouh Kabeel
Department of ophthalmology, Faculty of Medicine, Tanta University,
Egypt.
Tanta Med. Sc. J 2007; 2(3):147-154
Article type: Original article
Background/Aim: The use of trypan blue seems to
have less toxic effect to retinal pigment epithelium (RPE) than any
other stain as stated by Haritoglou. Retrospective study has
constructed by reviewing a series of 40 patients with stage II, III,
and IV, after doing standard pars plana vitrectomy and ILM-assisted
peeling by use of membrane blue dye (by DORC Company). Patients &
Methods: Idiopathic macular hole who underwent macular hole surgery
between September 2004 to September 2006. All patients done by me
with standard pars plana vitrectomy and ILM-assisted peeling by use
of membrane blue dye (by DORC Company). I followed up most of the
patients for up to 1 year post operatively stressing on the
functional and anatomical result of the surgery. Results: As regards
the visual improvement, 27 eyes (67.5%) showed significant
improvement in relation to their pre-operative level (P<0.05), while
8 eyes (20%), showed stabilization of their pre-operative level. And
5 eyes (12.5%) showed deterioration of vision. In the improved group
of eyes that composed of 27 eyes, 6 eyes were from grade II hole
(22.2%), 12 eyes were from grade III hole (44.4%) and 9 eyes were
from grade IV hole (33.3%) that means all grade II hole included in
this study showed substantial improvement in their visual acuity of
more than 3 lines. Also the duration of symptoms in improved group
was < 6 months in all eyes as demonstrated. For the stabilized cases
of 8 eyes (20%), none were from grade II hole. 2 eyes were from
grade III hole, and 6 eyes were from grade IV hole. For the 5
deteriorated eyes, 4 eyes were from grade III hole and 1 eye was
from grade IV hole, and the duration of symptoms in 4 of them were
>1year while only 1 eye was < 6 months, 4 of them need 2 surgeries
while only 1 needs one surgery. All the phakic eyes (21 eyes)
included in this study, 15 eyes (71.4%) end up with cataract
extraction after 6 months of the hole surgery and only 2 eyes in the
whole study have retinal detachment in the follow-up period that
necessitate another surgery with long tamponade with silicon oil.
Conclusion: in this study we have 2 eyes (5%) of retinal detachment
from the 40 initial patients due to sclerotomy related late retinal
break that needs another surgery with long lasting tamponade with
silicon oil.
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