Efficacy of intravitreal expansile gas alone for treatment of idiopathic full-thickness macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

Han Ruoan , Wu Chan , Zhang Xiao , Chen Huan , Zhang Chenxi ,  Chen Youxin

Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;

Corresponding author：

Chen Youxin, Email: chenyouxinpumch@163.com

Keywords：

Retinal perforations/surgery; Intravitreal injections; Noble gases

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.010

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ObjectiveTo evaluate the efficacy of intravitreal injection (IVI) of expansile gas alone to treat idiopathic full-thickness macular hole (FTMH).MethodsThis is a prospective interventional case series. Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study. There were 5 males (5 eyes) and 21 females (21 eyes), with the mean age of (59±12) years. All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography and three-dimensional optical coherence tomography (OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon, OCT-2000). Based on the diameter, the holes were classified as small FTMH (equal or lesser than 250 μm), medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm). The mean BCVA was 0.85±0.29. There were 7, 10 and 9 eyes with small, medium and large FTMH. There were 10 eyes with vitreous- macular traction (VMT). All the eyes received IVI of 0.2 ml C₃F₈ followed facedown positioning for 7-14 days. The follow-up ranged from 1 to 23 months. The BCVA, FTMH closure and complications were observed. If holes failed to close at 1 month after IVI, vitrectomy combined with internal limiting membrane (ILM) peeling and C₃F₈ tamponade would be performed for these eyes.ResultsFTMHs was able to close in 17/26 eyes (65.4%) had hole closure, failed to close in 9 /26 eyes (34.6%). All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas. The eyes failed in the closure initially with IVI of gas alone, all succeed with hole closure after vitrectomy combined with ILM peeling and C₃F₈ tamponade. The closure rate of small (6 eyes), medium (8 eyes) and large FTMH (3 eyes) was 85.7%, 80.0% and 33.3% respectively. The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8±122.8), (431.6±128.4) μm respectively, the difference was significant (t=−2.407, P=0.024). VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group, respectively, the difference was significant (t=−2.196, P=0.038). The mean preoperative BCVA was 0.51±0.36. There was a significant difference between pre-and postoperative BCVA (t=4.758, P＜0.05). Two eyes developed local retinal detachment, which achieved hole closure and retinal reattachment after vitrectomy.ConclusionIVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.

Citation： Han Ruoan, Wu Chan, Zhang Xiao, Chen Huan, Zhang Chenxi, Chen Youxin. Efficacy of intravitreal expansile gas alone for treatment of idiopathic full-thickness macular hole. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 368-372. doi: 10.3760/cma.j.issn.1005-1015.2017.04.010 Copy

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1. Spaide RF.Macular hole hypotheses[J]. Am J Ophthalmol, 2005, 139(1): 149-151. DOI: 10.1016/j.ajo.2004.09:027.
2. Woon WH, Greig D, Savage MD, et al. Asymmetric vitreomacular traction and symmetrical full thickness macular hole formation[J]. Graefe’s Arch Clin Exp Ophthalmol, 2015, 253(11): 1-7. DOI: 10.1007/s00417-014-2884-z.
3. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery[J]. Ophthalmology, 2002, 109(10): 1807-1813. DOI: 10.1016/S0161-6420(02)01179-X.
4. Banker AS, Freeman WR, Kim JW, et al. Visionthreatening complications of surgery for full-thickness macular holes[J]. Ophthalmology, 1997, 104(9): 1442-1452.
5. Park SS, Marcus DM, Duker JS, et al. Posterior segment complications after vitrectomy for macular hole[J]. Ophthalmology, 1995, 102(5): 775-781.
6. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. 1988, Retina, 2003, 23(6 Suppl): S629-639.
7. Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole[J]. Am J Ophthalmol, 1995, 119(6): 752-759.
8. Chan CK, Wessels IF, Friedrichsen EJ.Treatment of idiopathic macular holes by induced posterior vitreous detachment[J]. Ophthalmology, 1995, 102(5): 757-767.
9. Jorge R, Costa RA, Cardillo JA, et al. Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment [J]. Am J Ophthalmol, 2006, 142(5): 869-871. DOI: 10.1016/j.ajo.2006.05.062.
10. Mori K, Saito S, Gehlbach PL, et al. Treatment of stage 2 macular hole by intravitreous injection of expansile gas and induction of posterior vitreous dectachment[J]. Ophthalmology, 2007, 114(1): 127-133. DOI: 10.1016/j.optha.2006.07.001.
11. Chen TC, Yang CH, Yang CM.Intravitreal expansile gas in the treatment of early macular hole: reappraisal[J]. Ophthalmologica, 2012, 228(3): 159-166. DOI: 10.1159/000337840.
12. Duker JS, Kaiser PK, Binder S, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole[J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
13. Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography[J]. Arch Ophthalmol, 2002, 120(1): 29-35.
14. Ullrich S, Haritoglou C, Gass C, et al. Macular hole size as a prognostic factor in macular hole surgery[J]. Br J Ophthalmol, 2002, 86(4): 390-393.
15. Chang S. Controversies regarding internal limiting membrane peeling in idiopathic epiretinal membrane and macular hole[J]. Retina, 2012, 32 Suppl 2: S200-203. DOI: 10.1097/IAE.0b013e31825bc02b.
16. Cullinane AB, Cleary PE. Prevention of visual field defects after macular hole surgery[J]. Br J Ophthalmol, 2000, 84(4): 372-377.

Chinese Journal of Ocular Fundus Diseases

Efficacy of intravitreal expansile gas alone for treatment of idiopathic full-thickness macular hole

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