nationoreo.blogg.se - Hole in retina repair

The use of triamcinolone to ensure that the posterior hyaloid membrane and the perifoveal cortical vitreous has been completely removed is important, as this residual material may produce horizontal tension on the hole and prevent its closure.

We offer the following points that may improve success and facilitate the surgery: Peribulbar antibiotics and steroids were provided at the end of the case. The cannulas were removed, and the wounds were checked for watertight closure. An air-gas exchange was performed with octafluoropropane (C3F8) gas. A careful fluid-air exchange was performed to avoid inadvertently dislocating or amputating the flap. Additional OVD was then gently refluxed onto the flap over the hole to maintain the flap in good position (Figure 4). The flap was then maneuvered into place, draping over and into the macular hole with the soft-tip cannula while weighing down the flap with a dispersive OVD. To identify new peripheral pathology, 360º scleral depression was performed. A Tano Diamond Dusted Membrane Scraper (Bausch + Lomb) was used to gently mobilize the edges around the macular hole to release any adhesions that might prevent its closure (Figure 3). Grieshaber Advanced DSP Tip ILM Forceps (Alcon) were then used to propagate the flap along the arcades, taking care not to prematurely amputate or inadvertently narrow the flap width, until it was of adequate length to reach the extent of the hole (Figure 2).

Owing to the large peel area, a rotational pedicle flap was initiated with a FINESSE Flex Loop (Alcon), given the adherent nature of the ILM and the desire to produce a broad hinged flap. Diluted indocyanine green was then injected to identify the ILM and the extent of the previous peel, which had a radius of approximately 4.5 mm from the fovea, extending to the temporal edge of the optic nerve (Figure 1). Diluted triamcinolone was injected to identify retained vitreous, and a close shave of the vitreous base was performed. Trocars were placed in accordance with a standard 3-port 25-gauge PPV. After discussion, the patient agreed to undergo a second surgical attempt to close the hole. OCT imaging of the left eye confirmed the presence of a macular hole with perifoveal cystoid macular edema.

Dilated fundus examination revealed an avitric left eye with a full-thickness macular hole. Slit-lamp examination revealed posterior chamber IOLs in both eyes with an open posterior capsule in the left eye. The patient’s Snellen VA was 20/30 in the right eye and 20/100 in the left eye. Her ocular history also included cataract extraction with implantation of IOLs in both eyes and successful closure of a full-thickness macular hole in her right eye a few months prior. A month earlier, she had undergone a pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM) with sulfur hexafluoride gas endo-tamponade without successful closure of the macular hole. CASE REPORTĪ 59-year-old woman presented for evaluation of a persistent macular hole in her left eye. In this case of a persistent macular hole that failed to close with a primary surgery, we deployed a combination of techniques to achieve anatomical success with improvement in visual acuity. This includes persistent or refractory holes, for which a subsequent surgery typically has a lower success rate than a primary attempt. Since Kelly and Wendell introduced macular hole surgery in the 1990s, 1 numerous innovations and modifications have been introduced, particularly for advanced management of different hole types.