SURGICAL THERAPY OF MACULA HOLES WITH AND WITHOUT SERUM APPLICATION
K.S. Shin, G.W. Nietgen, J. Schmidt
Background: Is there a difference in anatomic and functional outcome if autologous serum in macula hole surgery by pars plana vitrectomy is being used?
Methods: In a retrospective study 70 eyes from 65 patients were investigated. These patients underwent surgery in our department between 1992 and 1997 due stage 2 to 4 macula holes. One group of patients (I) received no autologous serum and a second group (II) did. We compared the sex of patients, age, duration of symptoms and laterlity of the lesion. We especially determined the stage of macular holes as described by Gass et al. and the presence of epiretinal membranes (ERMs) and their influence on outcome.
Results: We determined a significantly higher anatomic occlusion rate of the macular holes in patients who received serum than in those with no application (68,6% versus 51,4%, p<0.05). Additionally a better increase in visual acuity was observed in group II (preoperative mean vision in both groups: 0.1; postoperative 0.125 in group I and 0.16 in group II). Other beneficial effects affecting outcome were a younger age, and early stage of MFO and a shorter duration of symptoms. Preoperative vision had a positive correlation in both groups (r>0.4) with postoperative vision and a negative correlation (r<-0.4) to perioperative differences in vision. Age, stage of MFO and duration of symptoms did not correlate within one group. Removal of ERMs in 35 eyes from both groups was followed by anatomical success in 27 eyes (75%), yet in 4 eyes without ERM removal the macular hole did not close.
Conclusions: Application of autologous serum in MFO surgery leads to a better anatomic occlusion and a better postoperative visual acuity of an idiopathic MFO. Early stages are more successful operated and ERM removal is additionally helpful additional. However, early decisions towards surgery have to be balanced with risks accompanying them.
Department of Ophthalmology, Philipps-University, 35037 Marburg, Germany