Abstract
Purpose: :
To report the outcomes of 25-gauge pars plana vitrectomy using sulfur hexafluoride and no prone positioning for repair of macular holes.
Methods: :
Retrospective chart review of 44 consecutive patients who underwent pars plana vitrectomy with internal limiting membrane peel for repair of stage 2-4 macular holes using 20-30% sulfur hexafluoride. No patient maintained prone positioning or underwent gas augmentation postoperatively.
Results: :
The closure rate was 88.6% (95% CI: 76%-95%). There were no differences in the closure rates of phakic compared to pseudophakic patients (21/23 versus 17/21, p=0.17, Fisher Exact test), or between Stage 2, 3 and 4 holes (12/13, 20/23 and 7/8 respectively, p=0.99, Fisher Exact test). In eyes successfully operated on, visual acuity improved from logMAR 0.61 (20/82) preoperatively to logMAR 0.483 (20/61) at 1 month (p=0.008) and to logMAR 0.396 (20/50, p=0.00002) at a mean of 10.8 months of final follow-up. Adverse effects noted were an elevation of the intraocular pressure over 30mmHg in 7/49 (14.3%) patients on the first post-operative day which persisted in 1 patient postoperatively and required filtering surgery, 2 postoperative retinal detachments (4.1%) and progression of cataract requiring cataract surgery in 7/23 (30.4%) phakic patients.
Conclusions: :
Macular hole closure rates similar to those achieved using pars plana vitrectomy with perfluoropropane and prone positioning can be achieved using sutureless 25-gauge vitrectomy with sulfur hexafluoride tamponade and no prone positioning in both phakic and pseudophakic patients.
Keywords: macular holes • clinical (human) or epidemiologic studies: outcomes/complications • vitreoretinal surgery