gms | German Medical Science

Purpose: Aim of the study was to evaluate the visual and anatomical outcome and the restoration of the retinal microstructure in SD-OCT after 23-Gauge transconjunctival sutureless pars plana vitrectomy and Brilliant Blue G (BBG)- assisted ILM peeling in patients with macular holes.

Methods: In a consecutive retrospective study in 41 eyes of 41 patients with macular hole a standardized 23-G transconjunctival sutureless pars plana vitrectomy with ILM-peeling and Gas tamponade was performed. All patients underwent preoperative measurements of visual acuity (VA), the maximum hole diameter, basis, height, and retinal changes using high resolution optical coherence tomography (SD-OCT; Spectralis; Heidelberg Engineering). Main outcome measures included visual acuity 1,3, and 6 month after surgery and the closure rate. We also evaluated photoreceptor inner/outer segment (IS/OS) integrity as seen in SD-OCT for correlation with visual outcomes after macular hole surgery as well as the roughness of the retinal surface postoperatively over time.

Results: At baseline mean best corrected visual acuity (BCVA) was 20/100 (0,7 logMAR). BCVA improved significantly to 20/50 (0,4 logMAR) after 1 month, to 20/50 (0,4 logMAR) after 3 months and to 20/63 (0,2 logMAR) after 6 months respectively. A closure rate of 95,1% was achieved. The morphological parameter photoreceptor IS/OS integrity was measured semiquantitatively and showed a positive correlation to BCVA. Number and depth of the indentations increased according to time after surgery.

Conclusion: Transconjunctival sutureless pars plana vitrectomy and Brilliant Blue G (BBG)- assisted ILM peeling in patients with macular holes is a save procedure and leads to good functional and anatomical results. The integrity of the IS/OS segment is a good predictive parameter for BCVA improvement after macular hole surgery. The retinal surface shows an increasing roughness after ILM-peeling.