Effect of debridement of the retinal pigment epithelium in full-thickness macular hole surgery

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Abstract
We assessed the efficacy of debridement of the retinal pigment epithelium (RPE) from the base of the macular hole during vitrectomy to treat 83 eyes of 75 patients with a stage 2 (n=29), stage 3 (n=35) or stage 4 (n=19) macular hole. Patients ranged in age from 51 to 77 years (mean, 67.6 years). Duration of symptoms preoperatively ranged from 1 to 120 months (average, 19.2 months). During vitrectomy for macular hole, the RPE at the base of the hole was gently aspirated with either a silicone-tipped extrusion needle or a blunt-tipped 27-gauge needle. Follow-up averaged 13.0 months (range, 3 to 36 months). The holes resolved in 73 (88%) of the 83 eyes after one surgical procedure. In 73 eyes with a follow-up period of 6 months or more, sixty-five (89%) showed improved VA of at least two lines of Snellen equivalent. Fifty-five (75%) eyes had a visual acuity (VA) of > or = 20/40. Our preliminary results suggest that RPE debridement from the base of the hole is a useful adjunct to vitrectomy for treating full-thickness macular holes.

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