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Sandro Di Simplicio Cherubini, Philip Alexander, Richard Newsom; The gas conundrum; which tamponade after surgery for full thickness macular hole?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1092.
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© 2017 Association for Research in Vision and Ophthalmology.
The choice of the right tamponade after full thickness macular hole (FTMH) surgery is crucial. Tamponade duration must be long enough to allow hole closure. However, long acting gas tamponade with C3F8 is associated with side effects and prolongs visual rehabilitation.The purpose of our study was to assess the results of macular hole surgery using different tamponade agents, to determine the most appropriate tamponade choice based on macular hole diameter.
A retrospective analysis of 444 consecutive patients who underwent surgery for full thickness macular hole was conducted. All patients underwent 3-port pars plana vitrectomy, internal limiting membrane peel, and isovolumetric gas tamponade. Phakic patients underwent phacoemulsification and IOL, even in the absence of visually significant cataract. Patients were not asked to posture but were asked to avoid lying supine for a week. Demographics, preoperative and postoperative complications were recorded. The size of the hole and post-operative closure were assessed using optical coherence tomography.
For holes smaller than 400 microns, there was no significant difference in success rate between gases. Success rates for SF6 (n=55), C2F6 (n=130) and C3F8 (n=56) were 96.4%, 99.2% and 96.4% respectively (Chi Squared p=0.306).For holes larger than 400 microns, there was a trend for C2F6 to be more effective than SF6 (97.8% vs 87.5%, p=0.06). C2F6 was more effective than C3F8 (97.8%, vs 88.8%, p=0.02). Macular holes bigger than 800 microns appeared to benefit from silicone oil tamponade rather than gas.Considering holes of all sizes, C2F6 was more effective than SF6 at achieving hole closure (98.6% vs. 93.7, p=0.033). Exploratory analysis revealed that for holes up to 534 microns, there was no significant difference between closure rates for SF6 and C2F6, but beyond this cutoff, C2F6 was the better tamponade agent.
Tamponade plays a crucial role in the good outcome of FTMH surgery. Our study supports the use of SF6 for holes up to 534 microns in size, C2F6 should be used between 535 and 800 microns, and above 800 microns, silicone oil tamponade should be considered.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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