TY - JOUR
T1 - The Effect of Pars Plana Vitrectomy and Transforming Growth Factor-Beta 2 without Epiretinal Membrane Peeling on Full-thickness Macular Holes
AU - Lansing, Mary B.
AU - Glaser, Bert M.
AU - Liss, Hillary
AU - Hanham, Ann
AU - Thompson, John T.
AU - Sjaarda, Raymond N.
AU - Gordon, Alan J.
PY - 1993
Y1 - 1993
N2 - Purpose: Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-β2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results. Methods: A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11–81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-02 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole. Results: Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling. Conclusion: The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-β2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.
AB - Purpose: Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-β2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results. Methods: A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11–81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-02 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole. Results: Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling. Conclusion: The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-β2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.
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U2 - 10.1016/S0161-6420(93)31561-7
DO - 10.1016/S0161-6420(93)31561-7
M3 - Article
C2 - 8510899
AN - SCOPUS:0027189583
SN - 0161-6420
VL - 100
SP - 868
EP - 872
JO - Ophthalmology
JF - Ophthalmology
IS - 6
ER -