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

2. 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

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

7. Operation Video

8. 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

9. POD #19

10. POD #19

11. Pre Op
POD#19
VA OD 0.06
VA OD 0.1

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

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

14. Stage

15. 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

16. 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

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

18. Case
VA 0.5

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