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Sandro Di Simplicio, Philip Alexander, Sarith Makuloluwe, Daniel Hornan, Stephen Lash, Richard Newsom; Posturing is not required after Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5073.
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© ARVO (1962-2015); The Authors (2016-present)
The need for posturing after surgery for full thickness macular hole (FTMH) remains the focus of debate. A recent pilot study suggested, whilst posturing is not needed for smaller holes, for holes larger than 400 microns closure rates are poor unless face-down posturing is performed. The purpose of our study was to assess the success of non-posturing macular hole surgery.
A retrospective analysis of 220 consecutive patients with full thickness macular hole was conducted. All patients underwent 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.
Mean age was 70 years (range 45-93, SD 7.4) and 162 patients (74%) were female. Macular hole size was small (<250µm) in 36 patients (16%), medium (250-400µm) in 77 patients (35%) and large (>400µm) in 107 patients (49%). Primary success (macular hole closed at 3 months after a single procedure) was achieved in 93.5% of patients. Primary success rate was significantly higher in holes <400 microns (97%) compared with holes >400 microns (90%), [chi-squared, p=0.021]. Success rate did not vary according to age or gender.
Macular hole surgery is highly successful without face down posturing. Even in holes larger than 400µm, primary success rates in our study are comparable to surgery with posturing.
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