title: Pearls in the management of macular holes.
abstract: We studied the efficacy of removing the retinal pigment epithelium (RPE) from the base of the macular hole to treat 124 eyes of 118 patients with stage 2 (n = 38), stage 3 (n = 52), or stage 4 (n = 34) macular hole. The patients ranged in age from 42 to 81 years (mean = 66.7 years), and the duration of symptoms preoperatively ranged from 1 to 140 months (average = 16.8 months). During vitrectomy for the macular hole, the RPE at the base of the hole was gently aspirated with either a silicone-tipped extrusion needle or a blunt-tipped 27-gauge needle. The follow-up period averaged 18.6 months (range = 3 to 48 months). The holes resolved in 112 (90%) of the 124 eyes after one surgical procedure. In 107 eyes with a follow-up period of 6 months or longer, 91 (85.0%) showed improved visual acuity of at least 2 lines of Snellen equivalent. The final visual acuity was 20/25 or better in 34 (31.8%) and 20/40 or better in 80 (74.8%) of the 107 eyes. A complication peculiar to RPE removal is the hypertrophy of the RPE. This complication was observed in 15 (14.0%) of the 107 eyes that were followed for 6 months or longer. From these results, I conclude that RPE removal will improve the anatomical and the visual results in selected macular hole cases.
authors.affiliation: Department of Ophthalmology, Miyazaki Medical College, Miyazaki, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nao-i
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000601:surgery*; D011183:Postoperative Complications; D012167:Retinal Perforations / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D058609:Visual Field Tests; D014821:Vitrectomy