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S.S. Couvillion, W.E. Smiddy, H.W. Flynn, Jr.; Outcomes of Macular hole Surgery using Silicone oil or Perfluoropropane gas: A Case–Control Study . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1966.
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Purpose:To compare the visual acuity results and macular hole closure rates using either silicone oil or perfluoropropane gas tamponade in a case–control study. Methods:The study design was a matched, case–control, retrospective chart review of all patients undergoing macular hole surgery with silicone oil (cases). These cases were compared to consecutive patients that underwent repair with an identical surgical technique using perfluoropropane gas tamponade (controls). The gas controls underwent surgery immediately before or after the oil cases, using the time most proximal to the date of the oil case surgery. All study patients underwent surgery by one of the authors between 1999 and 2002. Patients selected for silicone oil tamponade were unwilling to comply with the recommended prone positioning or required air travel that precluded the use of expansile gas. Results:The study population included 46 eyes of 44 patients. There are 23 study eyes in the oil cases and 23 eyes in the gas controls. Both groups had pars plana vitrectomy with detachment of the posterior cortical vitreous and injection of silicone oil or gas tamponade. The average macular hole duration prior to surgery was 3 months for oil cases and 7 months for gas controls. The average follow up was 12 months in both groups. Membrane peeling was performed in 19 of 23 eyes (82.6%) in the oil cases and in 20 of 23 eyes (88.4%) in the gas controls. Anatomic closure occurred in 82.6 % (19 eyes) of the oil cases and in 86.9% (20 eyes) of the gas controls. Mean visual acuity improved 0.1310 LogMAR (P=0.298) in the oil cases and 0.5093 LogMAR (P=0.001) in the gas controls. Final visual acuity improved 2 lines or better in 69.5% of the oil cases and in 91.3% of the gas controls (P=0.71). Conclusions:Better visual acuity and anatomic outcomes in the gas–controls suggest a more limited role for silicone in macular hole surgery. A larger sample of patients and a prospective study would avoid the possible bias in group selection.
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