Equivalent tamponade by room air as compared with SF6 after macular hole surgery

Hasegawa, Yuhei; Hata, Yoshinobu; Mochizuki, Yasutaka; Arita, Ryoichi; Kawahara, Shuhei; Kita, Takeshi; Noda, Yoichi; Ishibashi, Tatsuro

doi:10.1007/s00417-009-1120-8

Cited by 53 publications

(49 citation statements)

References 28 publications

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“…At first, Park et al used air tamponade with 4 days prone positioning and observed hole closure in 91 % (Park et al, 1999). A closure rate over 90 % has been reported using air, including our previous report (Hasegawa et al, 2009;Hikichi et al, 2011;Sato et al, 2003). The recent views concerning management after macular hole surgery can be divided into two general approaches.…”

Section: Discussionmentioning

confidence: 97%

“…In our previous study, hole diameter was the most important prognostic factor among them (Hasegawa et al, 2009). And, the high closure rates were recently achieved regardless of tamponade material, so, there are many reports regarding the selection of tamponade material and the necessity of positioning restrictions after macular hole surgery.…”

Section: Fig 1 Scheme Of the Isolation Theory Rpe; Retinal Pigmentmentioning

confidence: 96%

“…On the other hand, complications were rare according to our experiences when air was used as a tmaponade material because it is not expanded and is absorbed faster than long-acting gas. Indeed, the usefulness of air as a tamponade material after vitrectomy for macular hole has been recently reported (Hasegawa et al, 2009;Krohn , 2005;Sato et al, 2003). Hikichi et al reported that macular holes closed successfully after the primary vitrectomy in all eyes using air tamponade (Hikichi et al, 2011).…”

Section: Usefulness Of Room Air As a Tamponade Materialsmentioning

confidence: 99%

“…Their studies reported high closure rates of 91 % to 100 %. We also investigated the tamponade effect of air and the shortening of the prone positioning period (Hasegawa et al, 2009). In this study, the macular hole closure was postoperatively confirmed by optical coherence tomography once the macular area could be precisely examined through aqueous humor.…”

Section: Usefulness Of Room Air As a Tamponade Materialsmentioning

confidence: 99%

“…(Hasegawa et al, 2009) One unclosed case was finally closed after the retinal stretch and the exchange of vitreous cavity by 20 % SF 6 at 5 days after operation with 1 day prone positioning after reoperation. In another unclosed case, although we once judged the hole to be closed by optical coherence tomography images and the prone positioning was terminated as shown in Figure 4, the patient restarted prone positioning next day because the hole was confirmed not to be closed.…”

Section: Trial To Shorten Prone Positioning Periodmentioning

confidence: 99%

See 4 more Smart Citations

Postoperative Tamponade and Positioning Restrictions After Macular Hole Surgery

Hasegawa¹,

Mochizuki²,

Hata³

2012

Vitrectomy

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Section: Discussionmentioning

confidence: 97%

Section: Fig 1 Scheme Of the Isolation Theory Rpe; Retinal Pigmentmentioning

confidence: 96%

Section: Usefulness Of Room Air As a Tamponade Materialsmentioning

confidence: 99%

Section: Usefulness Of Room Air As a Tamponade Materialsmentioning

confidence: 99%

Section: Trial To Shorten Prone Positioning Periodmentioning

confidence: 99%

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Postoperative Tamponade and Positioning Restrictions After Macular Hole Surgery

Hasegawa¹,

Mochizuki²,

Hata³

2012

Vitrectomy

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Use of air in macular hole surgery

Gupta

2010

Graefes Arch Clin Exp Ophthalmol

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Dear Sir, Hasegawa et al. [1] are to be congratulated on their study demonstrating that there is no statistically significant difference between the use of room air and 20% SF6 in terms of macular holes (MH) closure rates. These results seem to have interesting ramifications that were not touched upon in their discussion, and are worth considering.Issues regarding the role of the gas bubble and the need to posture remain unresolved. In the original study as reported by Kelly and Wendel [2], the actual rationale behind face-down was not stated. There can be no doubt that posturing is a cumbersome requirement upon patients, many of whom are elderly. Recently, a review [3] compared the shortened-duration posturing and non-posturing studies in the literature, noting that similar anatomical and functional results were being achieved. In the same review, two theories regarding the role of the gas bubble-the buoyancy/tamponade hypothesis and the macular-hole isolation hypothesis ('waterproofing' [4] from the aqueous)-were considered. It was shown by Foster and Chou [5] that the only buoyancy force that can be in operation is if the retinal tissue is of a lower mass density than that of the gas, and since retinal tissue is clearly more dense than gas, there can be no buoyancy force arising from large gas bubbles. Furthermore, Stopa et al. [6] note that buoyancy forces can only be in operation if the bubble is immersed in fluid, a situation that clearly will not be the case in early gas-filled post-op days when MH have been shown to be closed [7,8]. The results of the numerous studies that report equivalent MH closure rates without face-down posturing seem to favor the macular isolation theory. Therefore, facedown posturing seems simply to be an additional means of isolating the macula, especially once the vitreous cavity fills with newly-secreted aqueous.Moreover, in terms of MH closure, it would be difficult to see how 'endotamponade' forces would help cellular migration and intercellular cross-linking across the floor of a MH upon a air/fluid interface, the currently understood healing response by which a hole closes [9]. This would apply to flat/ open-type holes. Additional considerations may apply to elevated/open holes. Technically, tamponade means to 'plug' and not 'press' [10]. In the context of retinal detachments, Foster and Chou [5] have shown that the forces that reattach retinal flaps in large gas bubbles arise from the liquid-gas (or liquid-air) interface and not buoyancy forces. Large gas bubbles envelop the entire tear, and since the pressure in the gas phase is uniform, the gas exerts equal pressures on both sides of the flap. The re-adhesion force arises from the surface tension of the liquid film covering the retina-RPE juncture, which acts to minimize the total gas-liquid interface. Similar considerations may apply to the MH with elevated edges: the surface tension helps to appose the retina to the RPE, with RPE-pump possibly playing a role in keeping the hole flattened (Tornambe 'hydration hypothesis...

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