Our Summary

This research paper discusses two different treatment methods for an eye condition called refractory macular hole. This is a problem where a hole forms in the macula, the part of the eye responsible for detailed, central vision.

In both cases, the patients had a procedure called a vitrectomy, which is where the vitreous (a jelly-like substance filling the eye) is removed to allow for other procedures to occur. The specific method used in each case depended on whether a thin tissue layer called the internal limiting membrane (ILM) was still present in the eye.

In the first case, where the ILM was present, the surgeons flipped the remaining flap of the ILM, did an air-fluid exchange (replacing the fluid in the eye with air), and inserted a type of gas to help the eye heal.

In the second case, where there was no ILM, the surgeons flipped and released the edge of the macular hole, added a substance made from the patient’s own blood to help healing (autologous platelet concentrate), did an air-fluid exchange, and inserted the same type of gas.

Both methods had good results, showing that these new surgical procedures could be a promising way to treat refractory macular holes depending on whether the ILM is present or not.

FAQs

  1. What is a vitrectomy and why is it used in the treatment of refractory macular holes?
  2. What were the different surgical methods used in the two cases of refractory macular hole treatment?
  3. What is the impact of the presence or absence of the internal limiting membrane (ILM) on the surgical procedure for refractory macular holes?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vitrectomy is to follow post-operative instructions carefully, including avoiding strenuous activities and heavy lifting, refraining from rubbing or touching the eye, and attending all follow-up appointments with the doctor. It is important to report any unusual symptoms or changes in vision to the doctor immediately. Additionally, maintaining good overall health, including managing any underlying medical conditions such as diabetes, can help improve the success of the surgery and overall healing process.

Suitable For

Patients who are typically recommended vitrectomy include those with refractory macular holes, retinal detachments, diabetic retinopathy, macular edema, vitreous hemorrhage, epiretinal membranes, and other vitreoretinal disorders. The decision to undergo vitrectomy is made on a case-by-case basis by a retinal specialist after considering the severity of the condition and the potential benefits of surgery.

Timeline

  • Before vitrectomy: The patient may have been experiencing symptoms such as blurred vision, floaters, and decreased visual acuity due to a refractory macular hole. The patient would have undergone various treatments such as observation, medication, or previous surgical interventions that were unsuccessful in closing the macular hole.

  • Day of vitrectomy: The patient would undergo a comprehensive eye examination and imaging tests to evaluate the macular hole and surrounding structures. The surgical team would explain the procedure, risks, and expected outcomes to the patient.

  • During vitrectomy: The patient would be placed under local or general anesthesia, and the surgeon would perform the vitrectomy procedure, which involves removing the vitreous gel from the eye and addressing any underlying issues such as removing the internal limiting membrane (ILM) or releasing the margin of the macular hole.

  • After vitrectomy: The patient would be monitored closely in the immediate postoperative period for any complications such as infection or retinal detachment. The patient would be instructed on postoperative care, including the use of eye drops, restrictions on physical activities, and follow-up appointments. Over time, the patient would experience gradual improvement in vision as the macular hole closes and the retina heals.

  • Follow-up appointments: The patient would have regular follow-up appointments with the surgeon to monitor the progress of the macular hole closure and assess visual acuity. Additional treatments or interventions may be recommended based on the patient’s response to the vitrectomy procedure.

What to Ask Your Doctor

  1. What is a vitrectomy and how does it work to treat refractory macular holes?
  2. What are the potential risks and complications associated with vitrectomy surgery?
  3. What is the success rate of vitrectomy for treating refractory macular holes?
  4. How long is the recovery process after vitrectomy surgery?
  5. Will I need any follow-up appointments or additional treatments after the surgery?
  6. Are there any lifestyle changes or precautions I should take after undergoing a vitrectomy?
  7. What should I expect in terms of visual improvement following the surgery?
  8. Are there any alternative treatment options for refractory macular holes that I should consider?
  9. How experienced are you in performing vitrectomy surgeries for macular holes?
  10. Can you provide me with any patient testimonials or case studies of successful vitrectomy surgeries for macular holes?

Reference

Authors: Kim JY, Kwon OW. Journal: Retin Cases Brief Rep. 2015 Fall;9(4):265-8. doi: 10.1097/ICB.0000000000000183. PMID: 26398430