Introduction:

Development of micro invasive technologies expands the indications for surgical treatment of vitreomacular pathology to the point of preventive type of surgeries. Use of mercury light, allows for mechanical detachment of posterior hyaloid (PH) from the internal limiting membrane (ILM) without vitrectomy or staining in the eyes with adhesion of the PH, stage 1 macular hole (Gass classification system).

Purpose:

To evaluate new micro invasive surgical strategy for preventive treatment of stage 1macular holes.

Methods:

The study included 40 patients (42 eyes), aged 51-75 years. All patients were diagnosed on optical coherent tomography (Cirrus HD-OCT) with foveolar adhesion of PH and cyst formation (stage 1 macular hole) and operated. Mean best-corrected visual acuity (BCVA) was 0.91±0.08.

Surgical technique:

Two transconjunctival ports were formed, for the light source and for the 27-gauge forceps. The forceps were carefully conducted towards the macula; PH was captured and detached from the foveola. This was followed by hermetic closure of the ports. Patients were followed with BCVA measurements, ophthalmoscopy, fundus photography, and HD-OCT for 6 months.

Results:

On the next day after surgery, HD-OCT showed complete detachment of the PHM from the fovea, without perforation, in all patients. ILM tears were never observed. All patients subjectively noted improvement in visual acuity and decrease of metamorphopsia. During the 6-month follow-up period, no full-thickness or lamellar perforation was observed. In addition, no other side effects were present during the intra- or post-operative period.

Conclusion:

Mechanical detachment of the PHM from the foveola without vitrectomy is an effective and safe method of prevention from formation of advanced macular holes for it allows eliminating the main cause of the disease with minimal harm to the intraocular structures.