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Malav Joshi, Ebrahim Elborgy, Jacek Kotowski, Jackson Abou Chehade, Raymond Iezzi; No face-down positioning for repair of reopened macular holes after initially successful repair. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5832.
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© ARVO (1962-2015); The Authors (2016-present)
The efficacy of the no face-down positioning after repair of idiopathic macular holes (MHs) has previously been reported. The objective of this study is to evaluate the efficacy of reoperation with no face-down positioning in patients referred to us with recurrent MHs after an initially successful repair.
We reviewed ten cases in ten eyes of re-opened MHs that were referred for repair by a single surgeon between August 2009 and November 2014 with no face-down positioning. Only MHs that remained closed for at least 3 months from the initial MH surgery were included. Four of the cases presented to Mayo Clinic as a second re-opening and had two MH surgeries prior to presentation. Nine of ten cases (90%) did not have the internal limiting membrane (ILM) peeled during their prior surgeries. In all cases, pars plana vitrectomy was performed with indocyanine green dye (0.08 mg/mL in D5W)-assisted, broad ILM peel (from arcade to arcade), and 20% SF6 gas tamponade. Patients were asked to avoid sleeping supine. During the day, patients were asked to sit upright, face forward, read, or work on a computer for the first week after surgery. Patients were asked to minimize physical activity and avoid driving, but were permitted to take walks. All patients were followed up for at least three months.
The mean duration from previous surgery was 8.7 years with a range of 6 months to 16 years. Six MHs had a basal diameter of ≥ 1000 μm. Mean MH basal diameter was 1115 μm. Mean preoperative best-corrected visual acuity (BCVA) was 0.83 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent (20/135) and mean postoperative month three BCVA was 0.55 logMAR units (Snellen equivalent 20/71). In all patients MH closure was achieved after single-procedure.
Macular hole surgery with broad ILM peeling, 20% SF6 gas, and no face-down positioning is effective in the surgical treatment of idiopathic MHs and comparable to using longer-acting tamponade or face-down positioning. A larger case series is needed to verify the findings.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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