Dlouhodobé výsledky chirurgického řešení idiopatické makulární díry s peelingem vnitřní limitující membrány

The Long-Term Results of Surgical Treatment of the Idiopathic Macular Hole with the Peeling of the Internal Limiting Membrane

The aim of the study was to confirm the surgical treatment of the macular hole by means of pars plana vitrectomy with the peeling of the internal limiting membrane and gas tamponade by 15 % perfluoropropane.

Methods:
The group consisted of 28 patients (24 women and 4 men) of the average age 68 ± 6.8 years. In two patients, subsequently both eyes were operated on. The stage of the macular hole was established according to the clinical findings and OCT examination in accordance with the Gass’ classification. The average follow up period of this group of patients was 14.7 ± 6.8 months. The final result of the surgery was verified at the end of the follow up period by means of clinical and OCT examination as well. In all 28 patients (30 eyes) with idiopathic macular hole, the standard pars plana vitrectomy with the peeling of the posterior hyaloid was performed. After air/fluid exchange, the trypane blue (Membrane blueTM) was applied for 2 minutes. The peeling of the stained internal limiting membrane in the macular region was performed and tamponade with 15 % perfluoropropane was used. The prone position of the patient’s head for the next two weeks was recommended. At the end of the follow up period, the best-corrected visual acuity (BCVA) was assessed.

Results:
The average follow up period was 14.7 ± 6.8 months. The staining of the internal limiting membrane was sufficient in all cases. The average visual acuity before the surgery was 0.89 ± 0.33 logMAR (0.2 – 1.7). At the end of the follow up period the average visual acuity was 0.67 ± 0.38 logMAR (0.2 ± 1.1). The visual acuity improved in 77 %, was stabilized in 20 %, and worsened in 3 % of cases. The BCVA improvement is statistically significant (p = 0.005). Metamorphopsia disappeared in 100 % of cases. The total closure of idiopathic macular hole (stage 1 according to Tornambe – flat/closed) was achieved in 26 eyes (87 %), flattening of the rim (stage 2 according to Tornambe – flat/open) was achieved in 4 eyes (13 %).

Conclusion:
The pars plana vitrectomy with the peeling of the internal limiting membrane represents an effective method of treatment of the idiopathic macular hole. The trypane blue (Membrane blueTM) staining facilitates the identification and delamination of the internal limiting membrane.

Key words:
idiopathic macular hole, trypane blue, pars plana vitrectomy, gas tamponade, peeling of the internal limiting membrane, prone positioning of the head.