The Eye Care Network is attending this year’s American Society of Retina Specialists (ASRS) meeting in Stockholm, Sweden. John T. Thompson, MD, a retina specialist in Baltimore, Maryland, spoke about his presentation, “Long-Term Results of Macular Hole Surgery With Long-Acting Gas Tamponade and Internal Limiting Membrane Peeling.”

Editor’s Note: The transcript below has been lightly edited for clarity

John T. Thompson, MD: Hi. I’m John Thompson, I’m a retina specialist in Baltimore. And my topic here is the long-term results of using ICG (indocyanine green) to peel the ILM (internal lining membrane), and the use of a long-acting gas bubble in the treatment of macular holes. And specifically I was looking at the long-term results in patients who were followed for at least 5 years. And the study was from a larger study of 250 consecutive eyes with primary macular holes, so these were all macular holes after primary surgery. And patients in this study, in the 250 patient study, there were a total of 83 patients, almost exactly a third of the patients, who were followed for 5 years or longer. And the goal was to look at the long-term outcomes of macular holes, both in terms of anatomic and functional success.

What I found is that initially, in this group of 83 eyes, all of the holes were closed by 3 months. However, there were two eyes that developed a late reopening of the macular hole between 6 and 7 years, which is a little unusual, but it did happen. So the overall success rate of one surgery for the eyes that were followed for 5 or more years was 98%. Now you would think that only the good eyes were followed for 5 or more years, but in reality, the success rate of the 250 eyes was also 98% for closing with one surgery. The visual outcomes were also very favorable. 52% of the eyes had a visual acuity of 20/40 or better at the final exam. And if you look at 20/63 at the final exam, that was also up, 82% of the eyes were 20/63 or better.

To look at it another way, the average visual acuity improved from 2100 preoperatively to 2050 at the last exam. The results were similar at the 1-year and 2-year exams. So these improvements in visual acuity are maintained. And unlike macular degeneration and some of the other conditions that we treat, the long-term outcomes in these eyes are excellent. There were a few complications, a few tears and a few peripheral detachments, none of which involve the macula. But overall, we seem to be very successful in treating macular holes. These eyes were all treated with ICG removal of the ILM and patients were placed in the prone position for 1 to 2 weeks. And part of the take-home message from this is that doing simple things like this, a peeling ILM and prolonged gas tamponade with the prone position, results in a very high success rate. And that makes it unnecessary to do these salvage techniques like autologous retinal transplantation or embryonic membrane transplantation in these eyes.