Macular Hole Surgery Without Face-Down Positioning

Tornambe, Paul E.; Poliner, Lon S.; Grote, Kurt

doi:10.1097/00006982-199705000-00001

Cited by 165 publications

(63 citation statements)

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“…Several mechanisms of action of the gas bubble have been postulated, from exertion of a large floatation force on the macula to preventing exposure of the macular hole to vitreous fluid. 4,16,17 The former requires strict prone posturing for effect; however, the latter does not.…”

Section: Discussionmentioning

confidence: 99%

Macular hole surgery without prone positioning

Tranos

Peter

Nath

et al. 2006

Eye

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Purpose To investigate the role of vitrectomy without prone posturing in the anatomic and functional outcome of macular hole surgery (MHS). Methods Forty-one consecutive eyes of 41 patients with stage II-IV full-thickness macular holes underwent pars plana vitrectomy and 16% C3F8 tamponade. In 25 cases posturing group (P), subjects were instructed to assume prone positioning for 10 days postoperatively, whereas in 16 cases nonposturing group (NP) patients were advised to avoid lying supine but no other posturing instructions were given. Preoperative, intraoperative and postoperative clinical data were collected, with macular hole closure rate and change in LogMAR visual acuity, contrast sensitivity, metamorphopsia, and 25-Visual Function Questionnaire (VFQ-25) being the primary outcome measures. Results Over a mean follow-up of 4.271.2 months, anatomical hole closure was noted in 22/25 (88%) and 14/16 (87.5%) in groups P and NP respectively. Visual acuity improved by a mean of eight letters and there was no significant difference in the two groups (P ¼ 0.724). Similarly, postoperative prone posturing did not have an effect on the final contrast sensitivity, metamorphopsia, and VFQ-25 composite scores (P ¼ 0.238, P ¼ 0.472, and P ¼ 0.87, respectively). However, eyes in group NP developed significantly more severe cataract in the early postoperative period (P ¼ 0.02). Conclusions Prone posturing following MHS provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for all phakic patients undergoing MHS.

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Section: Discussionmentioning

confidence: 99%

Macular hole surgery without prone positioning

Tranos

Peter

Nath

et al. 2006

Eye

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“…2,3,5 On the other hand greatest perioperative morbidity associated with macular hole surgery is also believed to be due to strict posturing. 6 Attempts at no posturing surgery 7 or use of silicone oil tamponade [8][9][10] have lower success rate and/or additional risks. The role of posturing in macular hole surgery remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…6 In view of this some surgeons have adopted a no posturing regime and one such study reported a 79% surgical success rate though all the phakic eyes underwent simultaneous cataract extraction with intraocular lens implantation. 7 Others have attempted to use silicone oil injection instead of gas to avoid strict posturing [8][9][10] but the technique has added risk of complications related to silicone oil and also requires second surgery for removal of oil. The role of posturing in macular hole surgery remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of posturing in macular hole surgery

Verma

Jalabi

Watts

et al. 2002

Eye

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Aim To objectively evaluate the postoperative face down posturing in macular hole surgery. Materials and Methods An electronic device called 'Maculog' was developed consisting of three basic components, a mercury switch triggered by the angle of tilt placed inside an earpiece, a data-recording device connected to the earpiece with cables and a windows based software program, specially written to analyse the recorded data in the form of tables and graphs. Ten patients undergoing macular hole surgery were fitted with the device on the first postoperative day before discharge. They were also asked for a subjective record of their posturing times. Four patients were given a posturing chair to take home. The device was retrieved after the first week and the data were downloaded to a PC for analysis. The actual posturing times recorded on the device were compared to the patients' own recollections. Results In all ten patients the actual posturing time was less than the time they had recorded themselves. The average actual posturing time was 48% of the perceived posturing time. The worst time for posturing, as expected, was between midnight and early morning. The compliance was better in patients who used the posturing chair. Conclusions It is feasible to quantify the time of posturing using an electronic device and computer analysis. The study has shown that the actual posturing time is significantly less than the perceived posturing time. A further large study using 'Maculog' is now planned to correlate actual posturing time to the results of macular hole surgery.

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“…Fortyeight per cent of eyes attained visual acuity of 20/50. 40 In another series that included 20 eyes, combined surgery with tamponade by 20% C2F6 without face-down posturing resulted in anatomical closure in 90% and improvement in visual acuity by at least 0.3 logMAR units in 95%. 41 An alternative proposal for patients who are unable to perform prolonged face-down posturing is the use of silicone oil tamponade.…”

Section: Surgical Approaches For Macular Holesmentioning

confidence: 96%

Macular holes: vitreoretinal relationships and surgical approaches

Bainbridge

Herbert

Gregor

2008

Eye

100

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Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of facedown positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dosedependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

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Macular Hole Surgery Without Face-Down Positioning

Cited by 165 publications

References 0 publications

Macular hole surgery without prone positioning

Macular hole surgery without prone positioning

Evaluation of posturing in macular hole surgery

Macular holes: vitreoretinal relationships and surgical approaches

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