Retinal sensitivity and fixation changes 1 year after triamcinolone acetonide assisted internal limiting membrane peeling for macular hole surgery--a MP-1 microperimetric study.
OBJECTIVE
To evaluate microperimetric changes 1year after macular hole surgery with triamcinolone acetonide assisted internal limiting membrane (ILM) peeling.


METHODS
Twenty-two eyes of 22 patients with stage 3 and 4 idiopathic macular holes of <6months' duration underwent vitrectomy with triamcinolone acetonide assisted ILM peeling. Best corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution), and central retinal sensitivity were documented before and 1, 3, 6, and 12months after surgery. Macular sensitivity (mean sensitivity in decibels -dB), and stability and location of fixation (preferred retinal locus) were determined using MP-1 microperimetry (Nidek). The MP-1 microperimetry sensitivity map was overlaid onto infrared images recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the fixation location before surgery. Anatomical success was evaluated with optical coherence tomography (OCT). Optical coherence tomography scans were recorded on an OCT 3000 scanner.


RESULTS
Anatomical success was achieved in all 22 eyes. All patients completed 1year follow-up. No recurrence of macular hole was seen in any patients in the follow-up period. The mean BCVA improved from 0.75±0.2 before surgery to 0.31±0.1 logMAR at the last visit (p<0.001). Mean sensitivity improved from 3.7±0.6 to 5.3±1.0dB at the last visit (p<0.001). Before surgery, the preferred retinal locus was located on the margin of the hole in all, in 18 eyes on its upper part and in four eyes to the side or on its lower part. Preoperatively, 12 eyes were stable and 10 were relatively unstable, but 12month after surgery, fixation stability had improved, and 20 eyes were stable and two were relatively unstable.


CONCLUSIONS
MP-1 microperimetry sensitivity map overlaid onto an infrared image using dedicated MP-1 software can be used successfully to evaluate fixation location in patients with a macular hole before surgery. With microperimetry findings, we can also measure functional macular changes more precisely than using BCVA alone after macular hole surgery. Our results also showed that retinal sensitivity and fixation properties were improved after vitrectomy with triamcinolone acetonide assisted ILM peeling in patients with idiopathic macular hole.
Ozdemir
Hakan
H
The Istanbul Retina Institute, Istanbul, Turkey Department of Biostatistics, Cerrahpasa School of Medicine, University of Istanbul, Istanbul, Turkey.
Karacorlu
Murat
M
Senturk
Fevzi
F
Karacorlu
Serra A
SA
Uysal
Omer
O
D000368:Aged; D001485:Basement Membrane / Q000187:drug effects / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000503:physiopathology*; D012167:Retinal Perforations / Q000503:physiopathology* / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D014821:Vitrectomy
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide