Outcomes of macular hole surgeries for macular telangiectasia type 2.

PURPOSE: To describe surgical outcomes of macular telangiectasia (MacTel) Type 2 associated full-thickness macular holes (FTMH) in 4 patients and to review the literature. METHODS: Retrospective interventional case series with a review of medical records, including optical coherence tomography. RESULTS: One eye of each patient underwent pars plana vitrectomy with internal limiting membrane peeling, gas tamponade, and prone positioning. In 2 patients, the holes did not close (final visual acuity: 20/70 and 20/200). In 1 patient, the hole reopened after 4 months (final visual acuity: 20/400). In the fourth patient, the hole remained closed (final visual acuity: 20/30). In contrast to the failed cases with large retinal cavitations seen on optical coherence tomography before FTMH formation, the successful case had small intraretinal cavitation before FTMH development, and the appearance of FTMH being similar to typical idiopathic FTMH. Adding these cases to the limited published reports resulted in closure rate of 30% for FTMH associated with MacTel. CONCLUSION: Since surgical outcomes for FTMH in MacTel Type 2 may be less successful than typical idiopathic FTMH, it is important to recognize that FTMH may be associated with MacTel. Lower success rate may be because of the pathophysiology of MacTel. The degree of tissue atrophy and appearance of FTMH on optical coherence tomography may guide surgical prognosis.

Intraoperative ketorolac and eye pain after viteoretinal surgery: a prospective, randomized, placebo-controlled study.

PURPOSE: To compare the efficacy of one intraoperative dose of intravenous ketorolac tromethamine to saline placebo in controlling postoperative eye pain, nausea, and sedation following vitreoretinal surgery. STUDY DESIGN: Prospective, randomized, placebo-controlled clinical trial. METHODS: One hundred fourteen vitreoretinal surgical patients were randomized over a 7-month period to a single intraoperative intravenous dose of ketorolac tromethamine or placebo. All patients underwent surgery with intravenous sedation and retrobulbar anesthetic injection and had access to a standard postoperative analgesic regimen. After 2 and 5 hours, eye pain, nausea, and sedation levels were recorded using a standard visual analog scale. Analgesic requirements were tabulated. RESULTS: Patients given ketorolac were significantly less likely to have postoperative eye pain than were placebo-treated patients (P = 0.0043). Fewer ketorolac patients required postoperative analgesia than placebo patients did (P < 0.0001). Four ketorolac patients (7%) required a narcotic compared to 11 placebo patients (20%) (P < 0.0001). Fewer ketorolac patients experienced nausea and sedation than placebo patients did, but this difference was not statistically significant. CONCLUSION: Ketorolac tromethamine is an effective nonnarcotic choice for postoperative pain control following vitreoretinal surgery. Pain control is particularly important in this group of patients, whose compliance with postoperative procedures and positioning may significantly affect surgical outcome.