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Impressum
Vitreoretinal surgery for idiopathic macular holes using autologous platelet concentrate and intraocular sulfur hexafluoride or perfluoropropane tamponade
Eckhardt S., Vij O., Schüler A. O., Schilling H., Bornfeld N.
Department of Ophthalmology, University of Essen, Essen
Objective: Idiopathic macular holes are a severe cause of significant
visual loss in elderly patients. A retrospective analysis of anatomic
and functional success, intra- and postoperative course after vitrectomy,
autologous platelet concentrate and intraocular gas tamponade is demonstrated.
Material und methods: We operated 56 eyes with idiopathic macular
holes (stage II - IV). Perfluoropropane (C3F8, group A) was used in 21
eyes, sulfur hexafluoride (SF6, group B) was used in 35 eyes. Age ranged
from 49 to 81 years (average 67 years), 73% were female, average followup
was 6 months (range from 1 to 28 months).
Results: Combined phacoemulsification (n = 3), cryocoagulation
(n = 20) and lasercoagulation (n = 2) were performed. Advanced cataract
formation (n = 18), retinal detachment (n = 8), temporary intraocular
pressure rise (n = 7), endothelial decompensation followed by keratoplasty
(n = 1), and development of temporal visual field defect (n = 1) were
seen. Surgery was anatomically successful in 53 of 56 eyes (95%) with
complete macular hole closure (group A 100%, group B 89%). Preoperative
visual acuity (log MAR) was 0,77 (A = B), on average, postoperative visual
acuity (log MAR) was 0,73 (group A 0,61, group B 0,80) on average. 23
of 56 eyes showed an improvement of visual acuity of at least 2 lines,
in 20 of 56 eyes visual acuity was stable (+/- 2 lines), 13 of 56 eyes
had a loss of visual acuity due to complications. 37 of 56 eyes reached
a visual acuity of at least 6/30 (log MAR 0,7).
Conclusion: Vitrectomy with using autologous platelet concentrate
allows stabilisation of visual acuity in idiopathic macular holes. Long-acting
gas tamponade with perfluoropropane (C3F8) appears superior to sulfur
hexafluoride (SF6) and profitable for anatomic and visual success. A prospective,
randomized, multicentric study to evaluate the effectivity of adjuvans
use versus ILM-peeling with short- versus long-acting gas tamponade is
planned.