Limited vitrectomy spares vitreous and reduces complications

Limited vitrectomy removes enough of the vitreous to relieve stress on macula

Roibeard O’hEineachain

Posted: Tuesday, May 21, 2019

A novel limited vitrectomy surgical technique can be a safe and effective option to treat perifoveal pathologies while also reducing the rates of iatrogenic tears and cataract, said Robert McGrath MD, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.

“Whereas traditional vitrectomy involves removal of all of the vitreous gel, in limited vitrectomy the surgeon removes only enough of the vitreous to relieve the stress on the macula. It also leaves a tag of vitreous attached to the fovea and does not induce a posterior vitreous detachment (PVD),” Dr McGrath told the Annual Congress of the Irish College of Ophthalmologists in Galway, Ireland.

In 34 patients who underwent limited vitrectomy for vitreomacular traction (VMT), mean visual acuity (VA) improved from 0.32 logMAR preoperatively (range: 0.0-0.8) to 0.21 (range: 0.0-0.7) by two weeks postoperatively and to 0.16 (range 0.0-0.4) at a median follow-up of 13 months. Furthermore, there were no cases of iatrogenic progression of VMT to macular hole and no cases of retinal detachment.

In six patients who underwent the procedure for full-thickness-macular-hole, mean VA improved from 0.52 logMAR preoperatively to 0.5 at two weeks and 0.26 at last follow-up. One case was converted to full vitrectomy and required SF6 tamponade because the vitreous tuft became detached. In another case, the macular hole didn’t close after the first surgery, but was successfully closed using an inverted inner limiting membrane flap technique.

Among two cases that underwent the procedure for sub-internal limiting membrane haemorrhage, the first case improved from 0.6 logMAR to 0.3 on day one and 0.1 by two weeks. The second case improved from 1.0 to 0.3 on day one and 0.0 by two weeks. Neither developed a PVD or cataract at last follow-up.