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Macular hole in retinitis pigmentosa patients: microincision vitrectomy with polydimethylsiloxane as possible
E M Vingolo1, S Valente1, E Gerace1
1Department of Ophthalmology, Polo Pontino, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Purpose:
To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) for macular hole (MH) in retinitis pigmentosa (RP) patients-retrospective and observational study.
Methods:
Three RP patients suffering from MH were evaluated by means of best corrected visual acuity, anterior and posterior binocular examination, spectralis high-resolution optical coherence tomography, MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and during the 36-month follow-up. Patients underwent simultaneous MIVS and microincision cataract surgery; IOL was positioned in capsular bag. Patients were hospitalised for 2 days after the surgery. Surgical procedure was performed according the following schedule: surgical removal of crystalline lens, MIVS with 23-gauge sutureless system trocars, core vitreous body removal, peeling of the inner limiting membrane, and balanced sterile saline solution-air-micro-structured polydimethylsiloxane (PDMS) exchange. PDMS tamponade, after 6 months starting from MIVS, was removed.
Results:
In all patients visual acuity increased after vitrectomy as a consequence of complete MH closure and restoration of retinal architecture. None of the patients developed ocular hypertension, or re-opening of MH during the 3-year follow-up. MP-1 bivariate contour ellipse area was reduced in its dimensions and improved in all patients demonstrating a better fixation.
Conclusions:
MIVS could be an effective treatment in RP patients with MH if medical therapy is not applicable or not sufficient. Finally more studies will be needed to improve knowledge about this genetic disease.
Insights
Microincision vitrectomy surgery (MIVS) effectively treated macular holes (MH) in retinitis pigmentosa (RP) patients, improving vision and retinal structure. Long-term follow-up showed sustained MH closure and better visual fixation without complications.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Genetics
Background:
- Retinitis pigmentosa (RP) is a group of genetic disorders causing progressive vision loss.
- Macular holes (MH) can develop in RP patients, further impairing central vision.
- Surgical intervention for MH in RP patients presents unique challenges.
