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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 3  |  Page : 259-60

Macular hole surgery.



Correspondence Address:
Arvind Kumar Dubey


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Source of Support: None, Conflict of Interest: None


PMID: 15510476

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Keywords: Basement Membrane, surgery, Humans, Retinal Perforations, surgery


How to cite this article:
Dubey AK, Dubey B. Macular hole surgery. Indian J Ophthalmol 2004;52:259

How to cite this URL:
Dubey AK, Dubey B. Macular hole surgery. Indian J Ophthalmol [serial online] 2004 [cited 2020 Jun 6];52:259. Available from: http://www.ijo.in/text.asp?2004/52/3/259/14573

Dear Editor,

This is in reference to the article published in your esteemed journal on "Macular hole surgery".[1]

The authors have demonstrated a higher rate of closure and greater visual improvement specifically for near vision with peeling of internal limiting membrane as compared to cases without ILM peel.

In the above connection we have the following observations:

We use triamcinolone suspension for identifying posterior cortical vitreous which makes it possible to identify even a single gel fibril attached to the edges or base of macular hole.

Removal of ILM only ensures complete removal of such gel vitreous which may be attached to the margins of the hole and cause persistent traction or mechanical obstruction. If this gel can be removed by other means, removal of ILM which is often traumatic can be avoided.

To our mind any studies comparing results of macular hole surgery with and without ILM peel, without using contrast visualisation for posterior cortical vitreous may not be producing an actual comparison. The authors have reported use of NaF1 0.6% to stain the clear vitreous but have mentioned that this enables complete removal of peripheral skirt of the vitreous, stating simultaneously that they have not done vitreous base surgery in any of their cases. In any case the authors have not used any contrast medium for visualisation of posterior gel vitreous, which is crucial. It is logical to conclude that injection of NaFl as presented by the authors is superfluous.

The authors have reported greater improvement for near vision in cases with ILM peel compared to cases without ILM peel. We have observed that the improvement in near vision is always greater irrespective of ILM peel in our series of macular hole surgeries. We further observed that there was greater improvement in near vision than for distance even in cases where the macular hole did not close completely. In addition our data indicates that even best corrected preoperative visual acuity for near was better than for distance in our series of cases.

It is a common observation that in all sight-restoring surgeries the corrected near vision is always more than distance vision, whether it is cataract surgery, retinal surgery or any other. There are several reasons for this. Firstly, the effect of magnification obtained by near correction is an aid. Second the illumination offered for near vision testing is conventionally higher than for distance and the patient has the advantage of adjusting the angle of viewing by altering the position of the reading object or his own position to the best visual angle and distance. In addition eccentric viewing by taking fixation at the best possible point of visual acuity plays an equally important role, more so in cases where the macular hole has not completely closed. The authors have offered no possible explanation for their observation. On the contrary there are reports in the literature indicating a poor functional though better anatomical outcome in macular hole surgery with removal of internal limiting membrane.



 
  References Top

1.
Das T, Parida S, Majji AB. Does internal limiting membrane peeling in macular hole surgery improve reading vision. Indian J Ophthalmol 2003;51:251-54.  Back to cited text no. 1
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