Sutureless 25-gauge vitrectomy for idiopathic macular hole repair.
BACKGROUND
We investigated the feasibility and safety of a 25-gauge, transconjunctival sutureless vitrectomy system for macular hole repair.


METHODS
Eighty-four eyes of 77 consecutive patients with idiopathic macular hole were operated on using a transconjunctival sutureless 25-gauge vitrectomy system. A complete vitrectomy was performed using triamcinolone acetonide to visualize the vitreous gel and to remove the posterior vitreous cortex. The macular hole was covered with autologous whole blood, and the internal limiting membrane (ILM) was stained with indocyanine green. The ILM was peeled and a fluid-air exchange performed. The globe was filled with gas, and the patient was kept in a prone position for 1 week. Surgery-related complications, macular hole closure on optical coherence tomography (OCT) and visual outcome were evaluated.


RESULTS
No intra- or postoperative complications were recorded. It was noted in particular that sclerotomies did not require sutures. No postoperative hypotony or endophthalmitis was observed. OCT showed macular hole closure in 93% of the cases. The median preoperative best-corrected visual acuity was 20/200 and improved significantly (p<0.05) to a median best-corrected visual acuity of 20/67 (median follow-up 6.5 months).


CONCLUSIONS
A 25-gauge transconjunctival sutureless vitrectomy, visualization of the vitreous with triamcinolone acetonide, protection of the macular hole with autologous whole blood and staining of the ILM using indocyanine green are safe and efficient techniques for macular hole repair.
Rizzo
Stanislao
S
Eye Surgery Clinic, Santa Chiara Hospital, Via Roma 67, 56100 Pisa, Italy. chiroftalmica@ao-pisa.toscana.it
Belting
Claudia
C
Cresti
Federica
F
Genovesi-Ebert
Federica
F
D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology
D004396:Coloring Agents; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green