OSLI Retina

January 2020

Issue link: http://osliretina.healio.com/i/1199850

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Page 52 of 67

January 2020 · Vol. 51, No. 1 51 Optical coherence tomography (OCT) (AngioVue; Op- tovue, Fremont, CA) scan confirmed a 971-µm chron- ic MH with flat atrophic margins. We performed a 23-gauge PPV (Alcon Laborato- ries, Fort Worth, TX) combined with cataract extrac- tion and intraocular lens implantation. A chandelier endo-illuminator was used to achieve bimanual ma- neuvers. The 23-gauge size was chosen to facilitate the insertion of the AM through the valved trocar. We performed a complete vitrectomy with exten- sive vitreous base shaving. The ILM was stained with a mixture of vital dyes (Dual Blue; DORC Interna- tional, Zuidland, Netherlands) and peeled away. We used a cutaneous punch (Disposable Biopsy Punch; Kai Medical, Solingen, Germany) of 1 mm diameter to cut an AM plug. The plug was nestled within the MH with the chorion layer facing toward the retinal pigmented epithelium. Fluid-gas exchange with 20% sulfur hexafluoride (SF 6 ) (Fluoron GmbH, Ulm, Ger- many) was performed at the end of the procedure. The patient was asked to maintain face-down posi- tioning for the first 5 days after surgery (Video avail- able at www.Healio.com/OSLIRetina). RESULTS On postoperative day 10, OCT imaging confirmed complete MH closure, and BCVA improved to 20/200. MH remained closed at 3 months after surgery, with BCVA improving to 20/100. Visual acuity remained stable during the entire follow-up. No adverse events were registered during the 6-month follow-up (Figure 1). DISCUSSION A PTMH is not a rare complication of blunt ocular trauma and represents 10% of all MHs. Spontaneous closure of PTMH is commonly reported between 44% and 67%, with a final BCVA recovery to 20/40 or bet- ter in more than 50% of cases. When spontaneous closure does not occur, PPV with ILM peeling and gas tamponade remains the gold standard of choice, with a percentage of success more than 90% and final BCVA of 20/40 in most of the cases described. Large, chronic PTMH is a rare complication with poor likelihood of closure. 15 The use of various adjuvant or biological tissue in MH surgery has been reported by various authors in order to improved hole closure rates and reaches bet- ter final BCVA recovery. ILM inverted flap or autologous transplant have been used with great anatomical results. Recent re- ports have shown that ILM implantation within the MH can induce gliosis of the retinal layers and result in poor final BCVA recovery. 16 Figure 1. Optical coherence tomography (OCT) shows chronic post-traumatic macular hole (MH) with flat margin and an epiretinal mem- brane. The caliper indicates the internal dimension of the MH (A). Three-month OCT showing amniotic membrane plug (red arrow) well positioned under the retina and complete closure of the MH (B).

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