Abstract Objective: To assess the anatomic outcome and visual acuities at follow-up after pars plana vitrectomy in the management of stage 2 macular holes. Design: Retrospective. Setting: Retina Consultants, Ltd, St Louis, Mo. Patients: Thirty-three patients, aged 43 to 75 years, with stage 2 macular holes. Intervention: Total pars plana vitrectomy with separation of the posterior hyaloid membrane and injection of intraocular gas followed by postoperative facedown positioning. Main Outcome Measures: Visual acuity and anatomic appearance of the macular hole. Results: Postoperatively, 20 (61%) of 33 eyes attained a visual acuity of 20/50 or greater. Twenty (61%) of 33 eyes showed an improvement in visual acuity, while nine (27%) of 33 were stable. Four (12%) of 33 eyes showed a decline in postoperative visual acuity with progression to a stage 3 macular hole. Twenty-five (76%) of 33 eyes showed stabilization or improvement in the appearance of the macular hole. Conclusions: Pars plana vitrectomy in conjunction with postoperative intraocular gas tamponade may result in visual and anatomic stabilization or improvement in eyes with stage 2 macular holes. However, because of limited natural history data, it is unknown whether these results are any better than those that might occur without surgery. References 1. Gass JDM. Idiopathic senile macular hole: its early stages and pathogenesis . Arch Ophthalmol . 1988;106:629-639.Crossref 2. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study 1991 . Arch Ophthalmol . 1991;109:654-659.Crossref 3. Glaser BM, Michels RG, Kuppermann BD, Sjaarda RN, Pena RA. Transforming growth factor-β2 for the treatment of full-thickness macular holes . Ophthalmology . 1992;99:1162-1172.Crossref 4. Lansing MB, Glaser BM, Liss H, et al. The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on fullthickness macular holes . Ophthalmology . 1993;100:868-872.Crossref 5. Fine SL. Vitreous surgery for macular hole in perspective: is there an indication? Arch Ophthalmol . 1991;109:635-636.Crossref 6. Johnson RN, Gass JDM. Idiopathic macular holes . Ophthalmology . 1988;95:917-924.Crossref 7. Smiddy WE, Michels RG, Glaser BM, de Bustros S. Vitrectomy for impending idiopathic macular holes . Am J Ophthalmol . 1988;105:371-376.Crossref 8. Wendel RT, Kelly NE, Patel A, Salzano TC. Macular hole surgery. Presented at the American Academy of Ophthalmology Annual Meeting; November 10,1992; Dallas, Tex. 9. Guyer DR, de Bustros S, Diener-West M, Fine SL. Observations on patients with idiopathic macular holes and cysts . Arch Ophthalmol . 1992;110:1264-1268.Crossref 10. Morgan CM, Schatz H. Idiopathic macular holes . Am J Ophthalmol . 1985;99:437-444. 11. Jost BF, Hutton WL, Fuller DG, et al. Vitrectomy in eyes at risk for macular hole formation . Ophthalmology . 1990;97:843-847.Crossref 12. Margherio RR, Trese MT, Margherio AR, Cartright K. Surgical management of vitreomacular traction syndromes . Ophthalmology . 1989;96:1437-1445.Crossref 13. Gass JDM, Joondeph BC. Observations concerning patients with suspected impending macular holes . Am J Ophthalmol . 1990;109:638-646. 14. Watzke RC, Allen L. Subjective slitbeam sign for macular disease . Am J Ophthalmol . 1969;68:449-453.
Archives of Ophthalmology – American Medical Association
Published: Mar 1, 1994