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J.C. Wickens, G. Shah; Macular Hole Surgery With Internal Limiting Membrane Peeling and Three Day Prone Positioning . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5429.
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Purpose:Internal limiting membrane peeling in macular hole surgery may allow a shortened period of prone positioning. This study reports the results of macular hole surgery combined with a shortened (3 day) prone position period by a single surgeon (GS). Methods: A retrospective review of 20 consecutive patients (20 eyes) that were treated for a stage II or stage III macular hole by a single surgeon (GS). All patients received a standard three port pars plana vitrectomy, triamcinolone–assisted internal limiting membrane peeling, and gas tamponade with either C3F8 16% or SF6 25%. All patients were instructed to remain in a prone position for 3 days at least 50% of the time. Anatomic closure rates, visual outcomes, and complications were evaluated. Results: The primary endpoint of macular hole closure was achieved in all eyes. Macular holes were classified as stage II in 7/20 eyes and stage III in 13/20 eyes. Demographic data reveal 14/20 (70%) patients were female. The average age was 67 years and the average follow–up period was 14 weeks with range of 4–48 weeks. Vision remained stable or improved in 14/20 (70%). Of the 6 patients with decreased vision, 5 were found to have significant cataract progression. One patient received intraoperative treatment for a retinal tear. Two patients had significant elevations of IOP (>40) on postoperative day 1 that were successfully treated with pressure lowering medications. Conclusions: This study reports that macular hole surgery with ILM peeling and a shortened period of prone positioning achieved anatomical closure and was not associated with significant adverse outcomes.
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