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N.G. Ghazi, A. Daccache, J.S. Tiedeman; Combined Pars Plana Vitrectomy/Lensectomy as a Primary Procedure for Idiopathic Macular Hole Repair Without Postoperative Prone Positioning. Results of a 10 Year Experience . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1468.
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to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic full thickness macular hole (MH) without postoperative prone positioning (PPP).
the charts of 37 patients (43 eyes) with MH who had CPPLV with 18% perfluoropropane (C3F8) tamponade were reviewed. Sulcus intraocular lens implantation (SIOL) was part of the procedure in each case. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week.
The duration of symptoms prior to presentation, and follow up varied from 1 week to 48 months (average 6 months) and 2 to 98 months (average 25.7 months) respectively. MH closure was achieved in 39 (90.7%) of 43 eyes. In these eyes, the average best corrected visual acuity (BCVA) improved from about 20/300 at baseline to 20/100 postoperatively, with 25 eyes (64.1%) having BCVA of 20/40 or better. Twenty five (58.1%) of all 43 eyes had a BCVA of 20/40 or better postoperatively and 30 eyes (69.8%) improved by at least 2 Snellen lines. Four eyes (9.3%) developed a new retinal detachment after surgery, and 2 other eyes had an existing detachment at the time of MH repair that recurred postoperatively. All 6 cases were successfully repaired. Three eyes (7.7%) had late reopening of the hole after initial closure.
CPPLV with SIOL implantation and C3F8 tamponade without PPP appears to be a viable option for MH repair. The anatomical and visual outcomes and the retinal detachment rate are comparable to those of previously reported techniques of MH surgery. The main advantages of this technique include sparing the patient the inconvenience of PPP and eliminating the need for an otherwise almost inevitable surgical intervention for post–vitrectomy cataract extraction.
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