Macular Hole Closure With Internal Limiting Membrane Abrasion Technique

Vinit B Mahajan; Eric K Chin; Ryan M Tarantola; David R P Almeida; Riz Somani; H Culver Boldt; James C Folk; Karen M Gehrs; Stephen R Russell

doi:10.1001/jamaophthalmol.2015.204

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Macular Hole Closure With Internal Limiting Membrane Abrasion Technique

Journal article

Open access

Peer reviewed

Macular Hole Closure With Internal Limiting Membrane Abrasion Technique

Vinit B Mahajan, Eric K Chin, Ryan M Tarantola, David R P Almeida, Riz Somani, H Culver Boldt, James C Folk, Karen M Gehrs and Stephen R Russell

JAMA ophthalmology, Vol.133(6), pp.635-641

06/2015

DOI: 10.1001/jamaophthalmol.2015.204

PMID: 25764352

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Abstract

Internal limiting membrane (ILM) abrasion is an alternative surgical technique for successful full-thickness macular hole (MH) repair. To study the effects of ILM abrasion as an alternative method of MH repair. Retrospective consecutive case series from January 2006 to December 2008. Demographic data and preoperative, intraoperative, and postoperative examination records of all patients were reviewed for patients who underwent ILM abrasion with a diamond-dusted membrane scraper during vitrectomy for MH repair. A total of 100 eyes underwent ILM abrasion as an alternative to traditional ILM peeling. Rate of MH closure and visual acuity (VA) outcomes at 3 months after surgery. Macular hole closure was achieved with a single surgical procedure in 94 of 100 eyes (94.0%; 95% CI, 87.4%-97.8%). Among all patients, the median preoperative VA was 20/100 (range, 20/30 to hand motions; 25th quartile, 20/60; and 75th quartile, 20/160), and the median postoperative VA at 3 months after surgery was 20/60 (range, 20/20 to hand motions; 25th quartile, 20/40; and 75th quartile, 20/100). Among all patients with stage 2 MHs, 30 of 38 patients (78.9%) had at least 2 lines of VA gain: 15 of 23 (65.2%) were phakic, and 15 of 15 (100%) were pseudophakic. Four of 38 patients (10.5%) with stage 2 MHs had at least 2 lines of VA loss, and all were phakic. Among all patients with stage 3 or 4 MHs, 42 of 62 (67.7%) had at least 2 lines of VA gain, of which 30 of 38 (78.9%) were phakic and 22 of 24 (91.7%) were pseudophakic. Six of 62 patients (9.7%) with stage 3 or 4 MHs had at least 2 lines of VA loss: 4 were phakic, and 2 were pseudophakic. In total, 35.0% (95% CI, 25.7%-44.3%) of patients achieved 20/40 vision or better, and 52.0% (95% CI, 42.2%-61.8%) of patients achieved 20/50 vision or better. Abrasion of the ILM with a diamond-dusted membrane scraper at the time of vitrectomy achieves high rates of MH closure. This technique avoids complete removal of the retinal ILM basement membrane and subjacent tissues and appears to provide MH closure rates similar to those of traditional ILM peeling.

Endotamponade

Prone Position

Tomography, Optical Coherence

Humans

Middle Aged

Retinal Perforations - physiopathology

Fluorocarbons - administration & dosage

Male

Visual Acuity

Basement Membrane - surgery

Sulfur Hexafluoride - administration & dosage

Basement Membrane - physiopathology

Ophthalmologic Surgical Procedures - instrumentation

Aged, 80 and over

Adult

Female

Retinal Perforations - surgery

Vitrectomy

Aged

Retrospective Studies

Ophthalmologic Surgical Procedures - methods

Details

Title: Subtitle: Macular Hole Closure With Internal Limiting Membrane Abrasion Technique
Creators: Vinit B Mahajan - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City2Omics Laboratory, University of Iowa, Iowa City
Eric K Chin - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Ryan M Tarantola - Saint Louis University Eye Institute, St Louis, Missouri
David R P Almeida - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Riz Somani - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
H Culver Boldt - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
James C Folk - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Karen M Gehrs - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Stephen R Russell - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
Resource Type: Journal article
Publication Details: JAMA ophthalmology, Vol.133(6), pp.635-641
DOI: 10.1001/jamaophthalmol.2015.204
PMID: 25764352
NLM abbreviation: JAMA Ophthalmol
ISSN: 2168-6165
eISSN: 2168-6173
Publisher: United States
Grant note: K08EY020530 / NEI NIH HHS
Language: English
Date published: 06/2015
Academic Unit: Stead Family Department of Pediatrics; Ophthalmology and Visual Sciences
Record Identifier: 9983979973202771

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