24–Hours Face–Down Positioning With Air Tamponade After Macular Hole Surgery

Abstract

Abstract: : Purpose: To evaluate the effectiveness of 24–hour face–down positioning following macular hole surgery with air tamponade in patients affected with stage III and IV macular holes. Methods: Seven phakic eyes of 7 patients affected by macular hole (three with stage III and four 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 face–down for 24 hours. Results: Five of the macular holes were closed with a single operation. Two stage IV eyes were managed with fluid–gas exchange (50% SF₆) a week after the primary surgical procedure. One eye failed as a consequence of not positioning face–down following surgery. This case required a second surgical procedure, with SF6 tamponade and four days of face down positioning. In all cases, the surgical procedure was anatomically successful at the three–month follow–up visit, with visual recovery of more than 2 Snellen lines. Conclusions: 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.

Keywords: macular holes • retinal detachment • retinal pigment epithelium