![]() ![]() Pic) the ILM from the surface more broadly, and The second step involves dissecting (usually with a vitreoretinal Is lifted to give a purchase site to dissect it from the retina. The author attempts to peel the ILM in all cases. Peeling, 1,2,18-20 it probably increases the success rate, 7,8,21 so While substantialĬlosure rates have been reported without ILM The second key maneuver is to peel the ILM. Retinal traction by the bubble postoperatively. Unwanted and uncontrollable postoperative peripheral 17 Maximal removal of vitreousĪllows smother fluid-air exchange later and avoids Excessive movements whileĪspirating with the vitreous cutter should be avoided to This technique confirms that the posterior hyaloid With the cutter and can be removed in standardįashion. Hyaloid usually separates readily into the periphery by aspirating Once the Weiss ring is mobilized, the rest of the Of the Weiss ring with other vitreous cortex (FigureġB). Off the nerve head, the author finds that using the vitreousĬutter on aspiration mode is more reliable and avoids confusion This same technique can be utilized to peel the Weiss ring Vascular arcades with posterior-to-anterior movementsįairly broadly and contiguously, regrasping and utilizing a Posterior hyaloid is engaged and lifted between the temporal With automated aspiration control to search for andĮngage an invisible, residual posterior hyaloid, manifestedīy the characteristic “fish-strike sign” (Figure 1A). 15 The most reliable way of inducing the separation is to use a flexible-tipped extrusion needle It can be deceiving to ascertain posterior hyaloid separation,Īs vitreoschisis is probably more widespread than Unless it is preexisting, posterior hyaloid separation is aĬrucial step that must be performed after the core vitrectomy. There are two maneuvers for MHS that engender specialĬonsideration: posterior hyaloid separation and ILM peeling. Options to peel the ILM improved disposable Small gauge instrumentation for MHS, however, is the constricted spectrum of instrument Studies have reported equivalent success with bothĢ3- and 25- gauge systems. The author's bias to use 20-gauge instrumentation, several Smaller gauge vitrectomy instrumentation. In recent years there has been a general trend toward ![]() Possible signs of chronicity and may also influence the visual Intraretinal edema or extent of subretinal fluid, which are Visual acuity may also vary based on factors such as Segment junction defect to be important determinants of Recent studies with OCT haveĭemonstrated the size and area of the inner segment/outer The prognosis with a macular hole of much more thanĪbout a year duration, especially if large, probably does not Variable prodrome or other conditions that confound the actual macular hole occurrence. Hole can be difficult to identify, not only Have long been recognized to carry a better prognosisĬannot change these factors, preoperative Preoperative vision, and lack of other extenuating circumstances Other considerations that may affect MHS outcomes.Įyes with shorter duration holes, smaller holes, better 7-9 The durationĪnd degree of internal tamponade has also recentlyīeen subject to debate. Likely has had the most positive effect on outcomes is peeling Reoperations, 4 high myopia, 5 and association with retinalĭetachment or trauma. Case selection is important poorer prognosisĬases include those involving larger holes, 2 chronic holes, 3 Technique modifications, some considerations may maximize In a number of settings with a variety of One of the most common indications for vitrectomy. Contact MDFA for further information.Macular hole surgery (MHS) has emerged as This chair will allow you to read, write, drink and socialise with minimal movement, while maintaining the correct posturing position. You may also consider hiring a posturing chair, which is ergonomically designed to allow you to posture without any strain on your back, chest or neck.
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