Prevention of visual field defects after macular hole surgery.

Hdl Handle:
http://hdl.handle.net/10147/209127
Title:
Prevention of visual field defects after macular hole surgery.
Authors:
Cullinane, A B; Cleary, P E
Affiliation:
Department of Ophthalmology, Cork University Hospital, National University of, Ireland Cork, Wilton, Cork, Republic of Ireland.
Citation:
Br J Ophthalmol. 2000 Apr;84(4):372-7.
Journal:
The British journal of ophthalmology
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209127
PubMed ID:
10729293
Abstract:
BACKGROUND/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. METHODS: 102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. RESULTS: In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. CONCLUSION: The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to differ from eyes in which a complete posterior vitreous detachment has been effected during surgery.
Language:
eng
MeSH:
Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures/adverse effects/methods; Optic Disk; Prospective Studies; Retinal Perforations/*surgery; Vision Disorders/etiology/*prevention & control; Visual Field Tests; *Visual Fields; Vitrectomy
ISSN:
0007-1161 (Print); 0007-1161 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorCullinane, A Ben_GB
dc.contributor.authorCleary, P Een_GB
dc.date.accessioned2012-02-03T15:12:59Z-
dc.date.available2012-02-03T15:12:59Z-
dc.date.issued2012-02-03T15:12:59Z-
dc.identifier.citationBr J Ophthalmol. 2000 Apr;84(4):372-7.en_GB
dc.identifier.issn0007-1161 (Print)en_GB
dc.identifier.issn0007-1161 (Linking)en_GB
dc.identifier.pmid10729293en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209127-
dc.description.abstractBACKGROUND/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. METHODS: 102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. RESULTS: In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. CONCLUSION: The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to differ from eyes in which a complete posterior vitreous detachment has been effected during surgery.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshOphthalmologic Surgical Procedures/adverse effects/methodsen_GB
dc.subject.meshOptic Disken_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshRetinal Perforations/*surgeryen_GB
dc.subject.meshVision Disorders/etiology/*prevention & controlen_GB
dc.subject.meshVisual Field Testsen_GB
dc.subject.mesh*Visual Fieldsen_GB
dc.subject.meshVitrectomyen_GB
dc.titlePrevention of visual field defects after macular hole surgery.en_GB
dc.contributor.departmentDepartment of Ophthalmology, Cork University Hospital, National University of, Ireland Cork, Wilton, Cork, Republic of Ireland.en_GB
dc.identifier.journalThe British journal of ophthalmologyen_GB
dc.description.provinceMunster-

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