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F. Giansanti, E. Rapizzi, L. Vannozzi, V. Borgioli, G. Razzoli, M. Scrivanti, U. Menchini; 24–Hour Facedown Positioning With Air Tamponade After Macular Hole Surgery: 18 Months Follow–Up . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3247.
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To evaluate the effectiveness of 24–hour facedown positioning following macular hole surgery with air tamponade in patients affected with stage III and IV macular holes.
Fifteen phakic eyes of 15 patients and three pseudophakic eyes of three patients affected by macular hole (12 with stage III and 6 stage IV) underwent two–port core vitrectomy, ICG assisted ILM peeling and 50% air fluid exchange. In all cases the surgical procedure was done using the microscope slit–lamp light source. At the end of the surgical procedure all the patients were positioned facedown for 24 hours.
Fifteen of the macular holes were closed with a single operation. Three stage IV eyes were managed with fluid–gas exchange (50% SF6) and four days of facedown positioning a week after the primary surgical procedure. One eye failed as a consequence of not positioning facedown following surgery. In 16 patients, the surgical procedure was anatomically successful at the three–month follow–up visit. All patients had a visual recovery of more than two Snellen lines at three months. Twelve patients improved visual acuity more than three Snellen lines at 18 months. Two patients with stage IV, although an incomplete macular hole closure, improved visual acuity of two Snellen lines.
Air tamponade following macular hole surgery with only 24–hours of face–down positioning is effective for achieving macular reattachment. However, the use of air requires meticulous patient compliance.
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