Macular hole surgery: Does C3F8 provide better anatomical and functional outcomes than SF6 and C2F6?

Abstract

 

Purpose

 

To assess differences in anatomical and functional outcomes when using C2F6, SF6 or C3F8 gas tamponade in macular hole surgery with 20G pars plana vitrectomy+ILM peeling+gas in a single VR unit (2005-2012).

 

Methods

 

Clinical and surgical data were prospectively entered in electronic medical records. Data collection included: demographic details, tamponade type, stage of macular hole, preoperative and postoperative BCVA, anatomical success rate by OCT and secondary cataract surgery rate.

 

Results

 

299 eyes of 276 patients with a mean age of 69.3±8.2 years (mean±SD)(median:69) and a 1:2.5 male to female ratio were included. The type of gas employed was C2F6 in 45.8% (137/299), SF6 in 18.1% (54/299) and C3F8 in 36.1% (108/299). No differences were observed in macular hole stage and type of gas employed at baseline. Mean preoperative BCVA was significantly worse in eyes treated with C3F8 compared to SF6 and C2F6 (0.94±0.37 logMAR vs 0.82±0.28 vs 0.84±0.28, p:0.034). No significant differences in postoperative BCVA were observed between gases at any timepoint but mean BCVA change from baseline was significantly better with C3F8 than SF6 and C3F8 at 12 months (-0.51±0.38 logMAR vs -0.43±0.30 vs -0.34±0.31, p:0.037). Closure rate assessed by OCT at 1 month was 95.5% for C3F8, 97.4% for SF6 and 92.3% for C2F6. However, closed holes with persistent foveal detachment on OCT 1 month after surgery were significatively less frequent in C3F8 treated eyes compared to SF6 or C2F6 (9.1% vs 37.8% vs 38.1%, p:0.056, p:0.036, respectively). At 3rd month, no significant OCT differences were observed between gases. Cataract surgery was performed at 11.61±6.1 months in C2F6 group, 9.62±5.5 in SF6 group and 11.54±7.19 in C3F8 group, with no significant differences between groups.

 

Conclusions

 

In our series, C3F8 was used in poorer vision eyes, provided better anatomical outcome at 1st month as assessed by OCT analysis and showed significantly higher vision gain at 12 months than SF6 and C2F6.

 

 

Visual outcomes at different timepoints. A. Mean BCVA for each gas type. B. Mean BCVA change from baseline.

 

 

Anatomical outcomes assessed by OCT. A. Preoperative OCT. B. 1 month post-surgery. Closed macular hole with hyporeflective space in outer retinal layers (foveal detachment). C. 3 months post-surgery. Resolution of foveal detachment. The photoreceptor IS/OS junction line and ELM appears anatomically preserved.

 

Keywords: 762 vitreoretinal surgery • 764 vitreous substitutes • 586 macular holes