الفهرس 
Types of Macular Hole (MH)Only 14 pages are availabe for public view
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Abstract
The reported rates of peripheral retinal break formation appear to be lower with narrow-gauge TSV using cannulated sclerotomy systems with breaks reported in 11–16% of procedures, and only 3−6% related to sclerotomies.(168)
RD has been reported in 2−6% of patients undergoing PPV for idiopathicMH.(169)
Symptomatic peripheral field defects are an uncommon finding (<1% of procedures) following PPV for idiopathic MH. .These are usually temporal and possibly related to vitreous separation or the consequences of fluid/air-exchange during surgery.(170)
Cataracts are very common following vitrectomy, especially in the >60 year-old age group and when long-acting gases are used. Progression of existing cataracts in patient undergoing PPV for idiopathic MH has been reported in 34% of patients at 12 months following the procedure.(171)
Combined phacovitrectomy has been widely adopted to avoid the need for subsequent cataract surgery. However, potential adverse effects of the procedure can be a higher incidence of posterior synechia formation and intraocular lens-related complications and a small (0.5 dioptre) myopic shift in refraction. Conversely, sequential surgery has been associated with a higher rate of posterior capsule rupture and other operative difficulties during the subsequent cataract surgery, associated with the lens–iris diaphragm syndrome after vitrectomy.(172)
Minor vitreous haemorrhage (with spontaneous resolution) has been reported for 5% of eyes undergoing 23-gauge TSV.(169)
Hypotony related to wound leakage is a concern with sutureless PPV, occurring in a reported 3–16% of eyes. In the majority of cases, this resolves spontaneously and its incidence is reducing as sclerotomy entry systems improve. However, there is an increased risk of complications such as hypotony-related retinopathy, choroidal effusions, and choroidal haemorrhage in severe cases.(173)
Endophthalmitis is very rare, occurring in 0.02–0.05% of cases. Initially, narrow-gauge vitrectomy was thought to be associated with a higher incidence of endophthalmitis than 20-gauge PPV; however, this has not proven to be true.(174)
Macular hole is a full thickness defect of the neural retina at the anatomic fovea that results in decreased central vision. And the patients notice that objects look distorted from the involved eye.
Types of macular holes are idiopathic,traumatic and myopic but most common type is idiopathic macular hole which affects mainly women in the seventh decade of life.
Macular hole is classified by Gass into 4stages and is diagnosed by amsler grid and flourecin angiography and optical coherence tomography( OCT).
Treatment of macular hole is pars plana vitrectomy surgery which includes complete posterior vitreous separation,peeling of eventual epiretinal membrane in the macula,tamponade with long acting gas and positioning of the patient strictly face down for the first post-operative week.
Endotamponade used are gass or silicone oil. Dyes used to stain the internal limiting membrane are indocyanine green, trypan blue and brilliant blue G(B.B.G).
The main complication of vitrectomy surgery is cataract .So combined phaco-vitrectomy procedure is the preferred surgical protocol for treatment of macular hole.