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David Almeida, Jonathon Wong, Michel Belliveau, Jaspreet Rayat, Jeffrey Gale; Outcomes Of Macular Hole Surgery: Interventional Prospective Case Series Of 50 Patients With Short-duration 3 Day Face-down Positioning. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4498. doi: https://doi.org/.
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The role of face-down posturing following macular hole surgery remains unclear and controversial. There is insufficient evidence to allow firm conclusions as to what duration of face-down positioning following macular hole surgery is optimal. The latter is complicated by the fact that maintaining face-down positioning is one of the major complaints of patients undergoing macular hole surgery and is associated with poor patient compliance. We evaluated the anatomic and visual outcomes of macular hole repair employing a short-duration (3 days) of prone positioning to aid in the clarification of the role of face-down posturing in macular hole surgical repair.
Prospective interventional case series of 50 eyes in 50 patients undergoing macular hole repair. Only patients with stage 2 or stage 3 idiopathic macular holes were recruited. All eyes underwent vitrectomy macular hole surgery with internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, macular hole closure rates, complications, and postoperative visual acuity were investigated. Primary objective is to study the anatomic and visual outcomes of macular hole repair employing a short duration of face-down posturing.
Anatomical closure of macular holes was achieved in 49 (98%) of 50 eyes by one surgery. Postoperative logMAR visual acuity decreased (i.e., improved) by 0.271 [95% confidence interval 0.101-0.441 (p-value=0.0024)]. Prior to surgery there were 5 (10%) eyes with VA 6/12 or better (logMAR ≤ 0.3); postoperatively, VA improved such that 19 (38%) eyes possessed VA 6/12 or better. One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure (IOP) fluctuations.
Vitrectomy with ILM peeling and gas tamponade with SF6 followed by short-duration 3 days face-down positioning is a successful surgical intervention for stage 2 and stage 3 idiopathic macular holes. Our current anatomical closure rate is one of the highest reported in the literature and is postulated to be attributed to: peeling of the ILM, the role of combined cataract surgery in macular hole repair, and the use of SF6 gas as a tamponade agent. This method possessed minimal complications and offered significant improvement in visual acuity.
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