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T. G. Heah, A. Rubinstein, A. Ang, C. K. Patel; Vitrectomy Without Postoperative Posturing for Idiopathic Macular Holes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4111.
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To determine the success of vitrectomy with ILM peeling and C3F8 tamponade for macular holes without the need of postoperative "face down" posturing.
24 eyes of 24 consecutive patients undergoing pars plana vitrectomy with ICG assisted ILM peeling and C3F8 tamponade without prone posturing were included in the study. All patients had follow-up on day-1, 2-week and 3-months postoperatively. Biomicroscopy and OCT were utilised to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre and postoperatively.
2/24 (8%) were stage II, 17/24 (71%) were stage III and 5/24 (21%) were stage IV macular holes. The mean duration of the holes was 8 months (range 4 - 12). 19/24 (79%) were phakic and 5/24 (21%) eyes were pseudophakic. 22/24 (91.6%) holes were closed at 3-month follow-up. In 2/24 (8.3%) eyes the holes remained opened. The two holes that failed to close were both stage IV macular holes. Pre-operative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Post-operative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Sixteen eyes had improvement of visual acuity of at least 2 lines on the snellen chart, 8 eyes had no improvement. No eyes had worse vision post-operatively. Five eyes had improvement of at least 3 snellen lines.
91.6% (22/24) of the holes were closed by 3 months, and this was confirmed by biomicroscopy and OCT. Macular hole surgery without "face down" posturing provides equally good anatomical and functional results as those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing.
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