Long term results of surgery for idiopathic macular hole

Year 2019, Volume: 16 Issue: 2, 370 - 374, 29.08.2019

Gülistan Oyur Leyla Hazar , Zeynep Alkın Mehmet Çakır

https://doi.org/10.35440/hutfd.534580

Abstract

Background: To evaluate the success and complications of
internal limiting membrane peeling using triamcinolone acetonide with 23 Gauge
sutureless vitrectomy in the treatment of idiopathic macular hole.

Methods: The study enrolled 44 patients (49 eyes) who
performed 23 Gauge pars plana vitrectomy (PPV), internal limiting membrane
(ILM) peeling (used triamcinolone acetonide) and intraocular gas tamponade for
macular hole at 2006-2011 in Beyoğlu Eye Training and Research Hospital. Stage,
best corrected visual acuity (BCVA), symptom duration , postoperative
functional and anatomic success with optical coherens tomography were
evaluated.

Results: The mean age was 67±9.51. Twenty eight
(57.1%) were female and 21 (42.9%) were male. Twenty six (53.1%) of the holes
were stage 3, 20 (40.8%) were stage 4 and 3 (6.1%) were stage 2. The mean
duration of complaints of macular hole was 4.14 ±3.22 months (1-12 months). The
mean follow-up period was  13,81± 9,44
months (6-58 months). Anatomical success was achieved in 44 (89.8%) patients.
It was two or more lines of visual increase 51% (25 eyes) with snellen. It was
observed that preoperative BCVAs were better in patients with a history of
visual loss less than 6 months. There was no statistically significant
relationship between the last BCVA and hole diameter, hole stage, preoperative
BCVA and type of tamponade. Postoperatively, 33 patiens (67.3%) developed
cataract and 3 patiens (6.1%) hypotonia.

Conclusions: 23 G sutureless PPV with triamcinolone
acetonide assisted İLM peeling results in high anatomical and functional
success for  the treatment of idiopathic
macular hole. It was concluded that early surgery was the most important factor
affecting BCVA.

Keywords

macular hole, triamcinolone acetonid

İdiopatik makula deliği cerrahisinde uzun dönem sonuçlarımız

Abstract

Amaç: İdiopatik makula deliği cerrahisinde
23G sütürsuz vitrektomi ile triamsinolon asetonid kullanılarak iç limitan
membran soyulmasını değerlendirmek.

Materyal
ve Metot:
Beyoğlu Göz Eğitim ve Araştırma Hastanesi’nde 2006-2011 yıllarında, makula
deliği nedeniyle 23 Gauge pars plana vitrektomi (PPV) ile iç limitan membran
(İLM) (triamsinolon asetonid yardımıyla) soyulan ve göz içi gaz tamponadı
uygulanan 44 hastanın 49 gözüne ait veriler retrospektif olarak incelendi. Yaş,
cinsiyet, makula deliği evresi, en iyi düzeltilmiş görme keskinliği (GK),
semptom süresi, cerrahi sonrası fonksiyonel başarı ve optik kohorens tomografi
ile anatomik olarak değerlendirildi.

Bulgular: Ortalama yaşları 67 ±9,51 olan
hastaların 28’i kadın (%57,1) ve 21’i (%42,9) erkekti. Deliklerin 26 tanesi
(%53,1) evre 3, 20 tanesi (%40,8) evre 4, 3 tanesi ise (%6,1) evre 2 idi.
Hastaların şikayet süresi ortalama 4,14±3,22 ay (1-12 ay) idi. Ortalama 13,81±
9,44 ay (6-58 ay) takip edilen hastaların 44’ünde (%89,8) anatomik başarı elde
edildi. Snellen eşeline göre 2 veya daha fazla sıra görme artışı olan hasta
oranı %51 (25 göz) oldu. Görme kaybı 6 aydan daha az olan vakaların hem
preoperatif en iyi düzeltilmiş GK hem de postoperatif en iyi düzeltilmiş
GK’ları daha iyi saptandı. Son vizitteki en iyi düzeltilmiş GK ile deliğin
evresi, delik çapı, preoperatif en iyi düzeltilmiş GK ve tamponad çeşiti
arasında anlamlı ilişki bulunmadı. Ameliyat sonrası, 33 hastada (%67,3)
katarakt, 3 hastada (%6,1) hipotoni gelişti.

Sonuç: 23 G sütürsuz PPV ile triamsinolon
asetonid kullanılarak İLM soyulması uygulanan idiopatik makula deliği
tedavisinin yüksek anatomik ve fonksiyonel başarı ile sonuçlandığı görüldü.
Erken dönemde başvuru ve erken cerrahinin sonuç en iyi düzeltilmiş GK’yı
etkileyen en önemli faktör olduğu sonucuna varıldı.

Keywords

makula deliği, triamsinolon asetonid, iç limitan membran

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