K 779Fluorescein angiographic findings after macular hole surgery
S. Staudt, F. G. Holz
Purpose: In the majority of patients with macular hole closure can be achieved with vitreoretinal surgical techniques. However, postoperative function is highly variable, and the prognostic determinants for visual acuity are incompletely understood. We evaluated postoperative fluorescein angiograms and visual outcome following macular hole surgery.
Methods: Between 10/1997 and 12/1999 macular hole surgery including vitrectomy, autologous platelet concentrate, air/C3F8-tamponade and postoperative positioning was performed in 74 eyes of 70 patients. Fluorescein angiograms with sufficient quality were obtained in 38 eyes using a confocal Scanning Laser Ophthalmoscope (Heidelberg Retina Angiograph, HRA, Heidelberg Engineering, Heidelberg) on average 4,2 months postoperatively. Visual acuity was determined with ETDRS-charts following a standardized protocol.
Results: Normal fluorescein angiograms were noted in 6 (15,8 %) of 38 eyes. 32 (84,2 %) eyes had abnormal angiographic findings. These included window defects (15,8%), irregular hyperfluorescence due to leckage of fluorescein dye with macular edema (ME) in the late phase (78,9%) including 2 eyes with prominent cystoid ME, and hypofluorescent spots corresponding to focal hyperpigmentations with a surrounding hyperfluorescent halo (7,9%). Mean postoperative vision was 0,3 (0,1 - 1,0) without significant difference between eyes with and without ME with regard to visual improvement from baseline (mean 3,7 and 3,0 lines, respectively). However, the proportion of eyes that were subjected to simultaneous or consecutive cataract surgery was greater in the group with ME (75,9 % vs. 37,5%).
Discussion: The results indicate that abnormal fluorescein angiographic findings are common in eyes that underwent macular hole surgery with subsequent anatomical success. Apparantly, the presence of macular edema is not associated with short term visual impairment. The higher incidence of ME in eyes with simultaneous or consecutive cataract surgery may reflect an increased vulnerability of the macular retina after macular hole surgery. Expanded longitudinal studies will reveal variations in ME with time and its relevance for long-term visual outcome.
Universitäts-Augenklinik Heidelberg, INF 400, D-69120 Heidelberg