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Hammouda Hamdy Ghoraba,1,2 Mahmoud Leila,3 Adel Galal Zaky,4 Tamer Wasfy,1 Haithem Maamoun Abdelfattah,2,5 Emad Mohamed Elgemai,2,6 Sameh Mohamed El Gouhary,4 Hosam Osman Mansour,7 Hashem Hammouda Ghoraba,1,2 Mohamed Amin Heikal8,9 1Ophthalmology Department, Tanta University, Tanta City, Gharbia, Egypt; 2Ophthalmology Department, Magrabi Eye Hospital, Tanta City, Gharbia, Egypt; 3Retina Department, Research Institute of Ophthalmology, Cairo, Egypt; 4Ophthalmology Department, Menoufia University, Shebein Elkoom City, Menoufia, Egypt; 5Ophthalmology Department, Benha Teaching Hospital, Benha City, Qualuopia, Egypt; 6Ophthalmology Department, Damanhour Teaching Hospital, Dmanhour City, Albehaira, Egypt; 7Alazahr University, Damietta City, Damietta, Egypt; 8Ophthalmology Department, Benha University, Benha City, Qualuopia, Egypt; 9Vitreoretinal Department, Magrabi Eye Hospital, Khober City, Eastern Province, Kingdom of Saudi ArabiaCorrespondence: Mohamed Amin HeikalOphthalmology Department, Benha University, Benha City, Qualuopia, 13511, EgyptTel +00201007131431Email mohammedheikel@gmail.comPurpose: To compare different types of macular holes regarding the anatomic and functional success following pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal.Methods: A retrospective review of all patients with macular holes treated by PPV, ILM removal with gas tamponade from January 2014 to July 2017 in Magrabi Eye Hospital.Results: One hundred fifty-seven eyes of 153 patients were analyzed. The eyes were classified according to the etiology of macular hole into four groups: 79 eyes with idiopathic macular hole (IMH), 51 eyes with traumatic macular hole (TMH), 16 eyes with macular hole in diabetic patients (DMH) and 11 eyes with myopic macular hole (MMH). We classified the IMH group based on the International Vitreomacular Traction Study Classification according to size into 3 subgroups; subgroup 1: ≤ 250μ, subgroup 2: > 250 to 400μ and subgroup 3: ≥ 400 μ. All types of macular hole showed statistically significant postoperative improvement in BCVA compared to the baseline except cases with MMH. Anatomic postoperative hole closure was achieved in 86.1%, 60.7%, 43.65%, an 45.46% of eyes with IMH, TMH, DMH and MMH, respectively. In eyes with IMH, closure rate in subgroup 1 was significantly higher than in subgroups 2, and 3.Conclusion: PPV, ILM peel and C2F6 technique yielded variable anatomic and functional outcomes in different types of macular holes. Anatomic results were most favorable in IMH and least favorable in MMH. The smaller the diameter of the hole the better the results. The underlying pathogenetic mechanisms that lead to different types of macular holes are pivotal in determining the final outcome.Keywords: ILM peeling, macular holes, pars plana vitrectomy |
