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    Clinical Round Up: No glaucoma protection from primary IOL placement in children

     

    Dr. Parolini and her colleagues conducted a study of the effectiveness of this approach in 50 eyes with myopic traction maculopathy. Twenty eyes underwent a combined vitrectomy and placement of a macular buckle and 30 eyes underwent only a macular buckle procedure.

    “The rate of retinal re-attachment was extremely high in both groups as was the rate of macular hole closure in eyes with a macular detachment,” she said. “The surgical time in the macular buckle group was half (average, 35 minutes) that in the combined surgery group.”

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    The best-corrected visual acuity may improve in these patients, she explained. In patients treated for a macular detachment with a macular hole, with the combined vitrectomy/macular buckle procedure and the macular buckle, only the patients either had improved vision or it remained unchanged from preoperatively.

    “This was true for macular detachments without macular holes and for macular foveoschisis,” she said.

    Complications of the macular buckle procedure included pain (mm2%), diplopia (4%), and extrusion through the conjunctive in 10% of the first 40 cases. Dr. Parolini pointed out that the extrusion was resolved when the buckle was shortened and use of the sponge was avoided in the lateral arm.

    The investigators found that 2 weeks and 6 months after the macular buckle surgery only without vitrectomy the detachments resolved.

    “Both procedures improved the vision in myopic traction maculopathy,” Dr. Parolini said. “The macular buckle only procedure is much faster and easier to perform compared with the combined procedure.

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    “I recommend that these patients undergo a buckle procedure alone first,” she continued. “Vitrectomy should never be performed without a buckle when there is posterior deep staphyloma. Combine vitrectomy and buckling in the presence of anteroposterior and tangential traction.”

     

    Barbara Parolini, MD

    E: [email protected]

    This article was adapted from Dr. Parolini's presentation at the 2014 meeting of the American Academy of Ophthalmology. Dr. Parolini did not indicate any proprietary interest in the subject matter.

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