title: LONG-TERM OUTCOMES OF 23-GAUGE PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND GAS TAMPONADE FOR MYOPIC TRACTION MACULOPATHY: A Prospective Study.
abstract: OBJECTIVE
  To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy.
  
  
  METHODS
  A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded.
  
  
  RESULTS
  Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test).
  
  
  CONCLUSIONS
  Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.
authors.affiliation: *Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain; †Vissum Madrid, Madrid, Spain; ‡Vissum Alicante, Alicante, Spain; and §Department of Ophthalmology, Hospital General La Mancha Centro, Ciudad Real, Spain.
authors.forename: Marta S
authors.initials: MS
authors.lastname: Figueroa
authors.forename: José M
authors.initials: JM
authors.lastname: Ruiz-Moreno
authors.forename: Fernando
authors.initials: F
authors.lastname: Gonzalez del Valle
authors.forename: Andrea
authors.initials: A
authors.lastname: Govetto
authors.forename: Concepción
authors.initials: C
authors.lastname: de la Vega
authors.forename: Raquel Núñez
authors.initials: RN
authors.lastname: Plascencia
authors.forename: Inés
authors.initials: I
authors.lastname: Contreras
authors.forename: Javier Lara
authors.initials: JL
authors.lastname: Medina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D058450:Endotamponade; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D041441:Retinoschisis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*
chemical_list: D005466:Fluorocarbons; C042852:perflutren