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Viscoelastic agent retention and failed macular hole surgery
Daniele Veritti1, Paolo Lanzetta, Francesco Bandello
1From the *Department of Ophthalmology, University of Udine; and †I.R.C.C.S. Fondazione G.B. Bietti, Rome, Italy.
Retinal Cases & Brief Reports
|November 13, 2014
Summary
Viscoelastic agents used during macular hole surgery may impede hole closure, leading to initial surgical failure. Subsequent surgeries without the agent successfully closed the macular holes in these cases.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Complications
Background:
- Macular hole surgery aims to restore vision by closing retinal defects.
- Indocyanine green dye is often used to visualize the internal limiting membrane during surgery.
- Concerns exist regarding indocyanine green toxicity to retinal pigment epithelium cells.
Purpose of the Study:
- To investigate the potential role of viscoelastic agent retention in macular hole surgery failure.
- To describe a series of cases where this complication may have occurred.
Main Methods:
- Retrospective analysis of three consecutive macular hole surgery cases.
- Detailed review of surgical techniques, including the use of viscoelastic agents to protect retinal pigment epithelium cells from indocyanine green.
Main Results:
- Macular hole repair failed in all three initial surgical attempts.
- Histopathological examination suggested the presence of retained viscoelastic material.
- Successful closure of the macular holes was achieved in all three patients upon repeat surgery.
Conclusions:
- Dispersive viscoelastic agents, when used to prevent indocyanine green toxicity, may inadvertently create a physical barrier hindering macular hole closure.
- This retention can be a significant factor contributing to surgical failure in macular hole repair.
- Avoiding or modifying the use of viscoelastic agents may improve outcomes in macular hole surgery.
