Scientific Online Resource System

Scripta Scientifica Medica

Inverted internal limiting membrane peeling technique with silicone oil tamponade for repair of recurrent large macular holes in vitrectomized Diabetic patients

Ilian Shandurkov, Petja Vassileva

Abstract

Purpose: To present a new approach to treatment of large macular holes in already vitrectomized eyes of patients with proliferative diabetic retinopathy, whose ILM has not been removed during primary surgery.

Patients and methods: Two eyes of two different patients with proliferative diabetic retinopathy which had undergone vitrectomy with endolaser 1.5 to 2 years before admittance to our department. No data for ILM peeling during surgery were available. Our OCT examinations showed macular holes with upper diameter of 765 μm in the first patient and 1160 μm in the second one. In both cases we combined two well-known surgical approaches: first, inverted ILM flap technique; second, long-term silicone oil tamponade for a period of 4 months.

Results: The macula of both patients was followed up by photographs and regular OCT-s on day one, month one and three months after silicone oil removal. The macular holes remained closed after removal of the tamponade agent. BCVA was 0.5 three months after the last surgery in both patients. During the final examination, macular contour seemed almost normal.

Discussion: Large, long-standing macular holes are less likely to be closed after pars plana vitrectomy. The inverted ILM flap technique has been recently reported to be successful in nearly 99% of patients with macular holes more than 400 μm in diameter. The position of the inverted ILM flap is much more controllable under silicone oil than under gas tamponade.


Keywords

inverted ILM peeling; silicone oil tamponade; recurrent macular holes

Full Text


References

Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study. Arch Ophthalmol, 1991;109:654-659.

Beutel J, Dahmen G, Ziegler A, Hoerauf H. Internal limiting membrane peeling with indocyanine green or trypan blue in macular hole surgery: a randomized trial. Arch Ophthalmol, 2007;125:326-332.

Hee MR, Puliafito CA, Wong C, et al. Optical coherence tomography of macular holes. Ophthalmology, 1995;102:748-56.

Alpatov S, Shchuko A, Malyshev V. A new method of treating macular holes. Eur J Ophthalmol, 2007;17:246-252.

Couvillion SS, Smiddy WE, Flynn HW, Jr, Eifrig CWG, Gregori G. Outcome of surgery for idiopathic macular hole: a case-control study comparing silicone oil with gas tamponade. Ophthalmic Surg Lasers Imaging, 2005;36:365-371.

Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane (ILM) flap technique for large macular hole. Ophthalmology, 2010;117:2018-2025.

Jumper JM, Gallemore RP, McCuen BW, 2nd, Toth CA. Features of macular hole closure in the early postoperative period using optical coherence tomography. Retina, 2000;20:232-237.

Michalewska Z, Michalewski J, Nawrocki J. Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography. Graefes Arch Clin Exp Ophthalmol, 2010;248:1249-1255.

Eckardt C, Eckert T, Eckardt U, et al. Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning. Retina, 2008; 28:1087-96.

Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial. Am J Ophthalmol, 2008; 146:128-34.

Tadayoni R, Vicaut E, Devin F, et al. A randomized controlled trial of alleviated positioning after small macular hole surgery. Ophthalmology, 2011;118:150-5.




DOI: http://dx.doi.org/10.14748/ssm.v46i4.1016
Array
Article Tools
Email this article (Login required)
About The Authors

Ilian Shandurkov
Eye Hospital `Prof. Pashev` of Sofia
Bulgaria

Petja Vassileva
Eye Hospital `Prof. Pashev` of Sofia
Bulgaria

Font Size


|