Treating persistent macular holes with heavy silicone oil

Injection of heavy silicone oil to treat persistent, full-thickness macular holes is safe and effective. The preoperative best-corrected visual acuity (BCVA) and the minimum linear diameter may predict the anatomic success,¹ according to Dr Tibor Lohmann, MD, lead author from the Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.

Dr Tibor and colleagues retrospectively studied 63 eyes with persistent, full-thickness macular holes after they underwent a primary pars plana vitrectomy and internal limiting membrane peeling; the patients then underwent a secondary surgery during which heavy silicone oil tamponade was used to close the hole. During follow-up the macular status was evaluated on spectral domain optical coherence tomography and the BCVA was measured.

The purpose of the study was to determine the anatomic success and the BCVA with use of the heavy silicone oil as a tamponade.

Anatomic and visual outcomes

The surgeries were successful anatomically in 50 (79.4%) of the 63 study eyes. In those 50 eyes, the BCVA before the first vitreoretinal surgery was significantly better compared with the eyes in which anatomic success was not achieved, respectively, 0.77 ± 0.24 (range, 1.3–0.3; ∼20/125 Snellen) logarithm of the minimum angle of resolution (logMAR); and 0.88 ± 0.17 (range, 1.1–0.6) logMAR; ∼20/160 Snellen) (P = 0.044).

In addition, in the eyes that achieved anatomic success compared with those that did not, the minimum linear diameter of the full-thickness macular holes was significantly smaller before the primary surgery, respectively, 403.4 ± 128.7 µm (range,199.0–707.0) and 568.1 ± 209.1 µm (range, 307.0–953.0); (P = 0.009) and the secondary surgery, respectively, 464.1 ± 215.0 µm (range, 178.0–1,521.0) and 663.3 ± 228.5 µm (range, 451.0–1,301.0) (P = 0.010).

The BCVA did not improve in patients who remained phakic during all surgeries, despite achieving anatomic success.

The study concluded, “Heavy silicone oil tamponade in a secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. The BCVA and minimum linear diameter before surgery may be indicators for anatomical success.”

Reference

1. Lohmann T, Schwarzer H, Koutsonas A, et al. Treatment of persistent macular holes with heavy silicone oil. Retina. 2022;42:2258-66; doi: 10.1097/IAE.0000000000003620