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Prospective Study for the Comparison of Two Surgical Procedures in Idiopathic Macular Holes
1Vehr S., 2Schnurrbusch U. E. K., 2Wiedemann P., 3Wolf S.,
1Augenklinik der Universität Leipzig (Leipzig)
2Universität Leipzig, Klinik und Poliklinik für Augenheilkunde (Leipzig)
3Klinik und Poliklinik für Augenheilkunde, Universität Leipzig (Leipzig)
Purpose: In this study we want to find out if full-thickness macular hole surgery with either removal of the Internal limiting membrane(ILM) or using autologous platelet concentrate is equivalent or better regarding visual acuity after one year. Secondly we want to figure out the efficacy of the two different surgical procedures concerning to the anatomical closure rate and required reoperations.
Methods: Inclusion criteria are idiopapathic macular hole stage 2 and 3 and visual acuity between 20/200 and 20/40. Exclusion criteria are the presence of epiretinal membranes and duration of symptoms more than one year. After randomisation the patients will subsequently operated with ILM peeling (group1) or with using platelet concentrate (group 2). In both groups the surgical procedure included pars plana vitrectomy, induction of the posterior vitreous detachment, fluid-gas exchange and injection of 20% SF6. Follow-up is intended to be done at 6 weeks, six months and 12 months after randomisation.
Results: Between 7/01 and 2/02 we included 20 patients in the study. After the first follow-up visual acuity improvemed in 45%, whereby 67% belong to group 1 (with ILM peeling) and 33% assign to group 2 (.with using platelet concentrate). Macular hole was closed in 75% totally. In group 1 complete closure of the hole was observed in 90%, in group 2 the anatomic success was achieved in 60%. After reoperation of persisting macular holes the anatomic success was 100%.
Conclusions: These preliminary results suggest that ILM peeling has advantages in anatomical closure and functional outcome compared to using autologous platelet concentrate. It seems to be an effective technique for the treatment of full-thickness macular hole.