Diabetic retinopathy에서 Macular hole Video conference Diabetic retinopathy에서 Macular hole R2 한재형/Pf.이원기

Case F/52 C/C : Decreased visual acuity(OD) for 1 month DM for 15yrs PDR(OU) 진단받고 3주전부터 좌안 PRP(x3) Hx. Visual acuity OD 0.06(0.08) OS 0.5(n-c) Anterior segment : WNL Fundus OD : Tractional membrane around fovea Multiple dot hemorrhage at 4Q

Assessment Plan R/O Macular hole due to traction membrane(OD) ppV+MP+ILM peeling+FAE+C3F8 gas inj.(OD)

Operation Video

POD #19 VA OD 0.1 Fds OD flat post. pole c gas fluid interface PreOp VA OD 0.06(0.08) VA OD 0.1 O-GAF, O-LON, O-1AT Fds OD flat post. pole c gas fluid interface

POD #19

POD #19

Pre Op POD#19 VA OD 0.06 VA OD 0.1

Diabetic retinopathy에서 Macular hole -RevieW Video conference Diabetic retinopathy에서 Macular hole -RevieW R2 한재형/Pf.이원기

Pathophysiology of MH Vitreomacular traction from the posterior vitreous surface : tangential traction of cortical vitreous on the fovea Antereoposterior transvitreal traction by vitreous fibers

Stage

Indication for treatment Stage 3 or 4 MH that cause reduced visual acuity 20/60~20/400 Definite, full-thickness, stage 2 or 3 MH with a visual acuity range between 20/40~20/60 Eyes with MH and visual acuity of less than 20/400 -> Coexisting condition check!!! Severe traumatic maculopathy Chroidal rupture Advanced diabetic retinopathy Retinal vascular abnormality Macular degeneration Severe glaucoma Optic nerve disorders, etc

Macular hole in DMR Uncommon complication of PDR Detachment area around hole is lager than idiopathic MH Greater traction on the macular d/t the presence of fibrovascular proliferation ILM peeling may not be essential for hole closure Visual prognosis was much worse than in idiopathic cases

Mechanism of secondary MH associated with Diabetic retinopathy : Information limited Tangential retinal traction MH formation by intraretinal exudation by Brazitikos et al.

Case VA 0.5

VA 0.03 ppV+ILM peeling ->VA 0.1, ->MH remained unclosed