Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outco
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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study Carsten H. Meyer 1 & Peter Szurman 2 & Christos Haritoglou 3,4 & Mathias Maier 5 & Armin Wolf 4 & Lyubomyr Lytvynchuk 6 & Siegfried Priglinger 4 & Jost Hillenkamp 7 & Joachim Wachtlin 8,11 & Matthias Becker 9 & Stefan Mennel 10 & Michael J. Koss 3 Received: 16 January 2020 / Revised: 14 April 2020 / Accepted: 6 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. Methods Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. Results The mean duration of the MH prior to SR-fluid application was 17 months (6–96 months). The mean age of the patients at the time of surgery was 72 years (54–88). The mean preoperative aperture diameter of the opening was 1212 μm (239–4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01–0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02–0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. Conclusion Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events. Keywords Vitreoretinal surgery . Vitrectomy . Macular hole . Subretinal fluid . Retreatment . Large aperture
This article is part of the Topical Collection on Macular Holes. In parts presented at the annual meetings of the Retinologische Gesellschaft 2019 Ludwigshafen, EURETINA 2019 meeting in Paris and Retina Society 2019 in London. * Carsten H. Meyer [email protected]
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Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
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Department of Ophthalmology, University Würzburg, Würzburg, Germany
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Department of Ophthalmology, Sankt Gertrauden Krankenhaus, Berlin, Germany
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Augenärzte Kammanneye, Davos, Switzerland
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Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany
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Department of Ophthalmology, Herzog Carl Theodor Eye Clinic, Munich, Germany
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Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland
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Department of Ophthalmology, Tech
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