ABSTRACT
Objetivo Describir la restauración anatómica y funcional observada a largo plazo en pacientes intervenidos por agujero macular (AM) grande empleando distintas técnicas de interposición macular. Método Análisis retrospectivo de los resultados obtenidos en una serie de 9 pacientes sometidos a cirugía de AM grande (≥450μm) realizando 4 técnicas de interposición macular distintas: flap invertido de membrana limitante interna en 4 casos, plegado de membrana limitante interna en 2, injerto de membrana amniótica en 2 e injerto autógeno de cápsula anterior en uno. El tiempo de seguimiento medio fue de 11 meses. Anatómicamente las medidas de resultados exploradas fueron la restauración de las capas externas de la retina y el patrón de cierre macular. Funcionalmente se valoró la agudeza visual final y la calidad visual. Resultados La restauración de las capas externas fue parcial en 6 casos. La tasa de cierre macular fue del 100%, apreciándose un patrón incompleto en 4 casos. La agudeza visual mejoró en 7 pacientes, manteniéndose estable en 2. Tres casos mostraron un patrón de fijación excéntrico y/o metamorfopsias. Conclusiones El desarrollo de nuevas técnicas quirúrgicas ha incrementado la tasa de cierre macular en AM grandes. Sin embargo, la restauración anatómica y funcional sigue siendo impredecible. En este trabajo se logró el cierre macular en todos los pacientes y una mayor tasa de cierre completo empleando flap invertido de membrana limitante interna. La restauración de las capas externas fue más favorable en los grupos en los que se había empleado membrana limitante interna. La recuperación funcional fue independiente de la técnica empleada (AU)
Objective To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. Method Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450μm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. Results The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. Conclusion The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used (AU)
Subject(s)
Humans , Male , Female , Aged , Retinal Perforations/surgery , Tomography, Optical Coherence , Retrospective Studies , Vitrectomy/methods , Visual AcuityABSTRACT
OBJECTIVE: To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. METHOD: Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450µm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. RESULTS: The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. CONCLUSIONS: The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used.
