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K. Masuyama, K. Yamakiri, Y. Sonoda, N. Doi, T. Sakamoto; Macular Hole Closure in Gas-Filled Eyes at Early Post-Operative Time Proven by Fourier- Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4680. doi: https://doi.org/.
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Although the success rate of macular hole surgery is high, the necessity of prone position for a certain period after surgery is painful for patients. Major obstacle to shorten the prone position period would be the difficulty to confirm macular hole closure in gas-filled eyes. Time-domain optical coherent tomography (OCT) can depict the retinal configuration, but cannot identify the macular area accurately in gas-filled eyes. On the other hand, serial thin section scanning of Fourier-Domain (FD) OCT can identify the macular area correctly. Using this characteristic of FD-OCT, macular area was examined in gas-filled eyes with macular hole from the early post-operative period.
A prospective study of interventional consecutive case series. Macular hole eyes received a standard pars plana vitrectomy with internal limiting membrane peeling, then eyes were filled with SF6 gas at the end of surgery. Cataract surgery and intraocular lens implantation were performed when needed. The patients maintained a prone position one night and the macular area was examined by serial scanning of FD-OCT (OCT-1000, Topcon, Tokyo, Japan) from next day. Once macular hole closure was confirmed by this method, a prone position restriction was removed. After a gas disappeared, macular area was examined again.
Ten eyes were enrolled (male 4 and female 6) with average age of 63.5 years old. Two eyes were stage 2, four eyes were stage 3 and four eyes were stage 4. Macular hole closure was confirmed in 8 eyes (80%) next day and 2 eyes (20%) on day 2. Macular hole remained closed in all eyes after disappearance of gas after 2 months.
FD-OCT enabled us to confirm macular hole closure next day after surgery even in gas-filled eyes and the subsequent removal of position restriction did not affect the closure. Confirmation of macular hole closure by FD-OCT at early post-operative time could reduce the period of painful prone position of patients.
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