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Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery.

Rishi P, Reddy S, Rishi E - Indian J Ophthalmol (2014)

Bottom Line: A 65-year-old lady presented with decreased vision in left eye since seven months.OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure.However, larger studies with longer follow-up are required to validate this finding.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, 18 College, Chennai, Tamil Nadu, India.

ABSTRACT
A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C ₃ F ₈ gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C ₃ F ₈ gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.

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Related in: MedlinePlus

Six weeks after primary surgery. OCT showing type 2 closure of macular hole with cuff of subretinal fluid at the edges of the hole. Basal diameter of the macular hole is reduced
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Figure 2: Six weeks after primary surgery. OCT showing type 2 closure of macular hole with cuff of subretinal fluid at the edges of the hole. Basal diameter of the macular hole is reduced

Mentions: A 65-year-old lady presented with diminution of vision associated with distortion of images in the right eye since the past seven months. On examination, her best corrected visual acuity (BCVA) was 6/9, N6 in the right eye and 6/36, N36 in the left eye. Biomicroscopic examination revealed nuclear sclerosis grade 2 with posterior subcapsular cataract in both eyes. Left fundus revealed an idiopathic, full-thickness macular hole in the left eye [Fig. 1a] confirmed on OCT [Fig. 1b]. Hole formation factor (HFF) was noted to be 0.80 and the basal diameter was 949 microns. Right eye fundus was normal. The patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, ILM peeling and 14% C3 F8 gas injection in the left eye. The patient was advised postoperative prone positioning (12-14 h per day for two weeks). On a follow-up six weeks after surgery, fundus examination revealed type II macular hole closure, confirmed on OCT [Fig. 2]. HFF was noted to be 0.80 while the basal diameter was reduced to 923 microns. BCVA was 6/36, N18 in the left eye. Retreatment options were explained to the patient . Four weeks later, patient underwent re-surgery; fluid–gas exchange with 14% C3 F8 gas injection was done and postoperative prone positioning as before, was advised. Repeat ILM peeling was not required as ILM re-proliferation was not noted at the time of re-surgery. On a follow-up two weeks after re-surgery, left eye revealed complete closure of the hole [Fig. 3a, b], confirmed on OCT. BCVA improved to 6/36, N12 in the left eye.


Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery.

Rishi P, Reddy S, Rishi E - Indian J Ophthalmol (2014)

Six weeks after primary surgery. OCT showing type 2 closure of macular hole with cuff of subretinal fluid at the edges of the hole. Basal diameter of the macular hole is reduced
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061686&req=5

Figure 2: Six weeks after primary surgery. OCT showing type 2 closure of macular hole with cuff of subretinal fluid at the edges of the hole. Basal diameter of the macular hole is reduced
Mentions: A 65-year-old lady presented with diminution of vision associated with distortion of images in the right eye since the past seven months. On examination, her best corrected visual acuity (BCVA) was 6/9, N6 in the right eye and 6/36, N36 in the left eye. Biomicroscopic examination revealed nuclear sclerosis grade 2 with posterior subcapsular cataract in both eyes. Left fundus revealed an idiopathic, full-thickness macular hole in the left eye [Fig. 1a] confirmed on OCT [Fig. 1b]. Hole formation factor (HFF) was noted to be 0.80 and the basal diameter was 949 microns. Right eye fundus was normal. The patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, ILM peeling and 14% C3 F8 gas injection in the left eye. The patient was advised postoperative prone positioning (12-14 h per day for two weeks). On a follow-up six weeks after surgery, fundus examination revealed type II macular hole closure, confirmed on OCT [Fig. 2]. HFF was noted to be 0.80 while the basal diameter was reduced to 923 microns. BCVA was 6/36, N18 in the left eye. Retreatment options were explained to the patient . Four weeks later, patient underwent re-surgery; fluid–gas exchange with 14% C3 F8 gas injection was done and postoperative prone positioning as before, was advised. Repeat ILM peeling was not required as ILM re-proliferation was not noted at the time of re-surgery. On a follow-up two weeks after re-surgery, left eye revealed complete closure of the hole [Fig. 3a, b], confirmed on OCT. BCVA improved to 6/36, N12 in the left eye.

Bottom Line: A 65-year-old lady presented with decreased vision in left eye since seven months.OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure.However, larger studies with longer follow-up are required to validate this finding.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, 18 College, Chennai, Tamil Nadu, India.

ABSTRACT
A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C ₃ F ₈ gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C ₃ F ₈ gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.

Show MeSH
Related in: MedlinePlus