Outcomes of Macular Hole Surgery and Shortened Face Down Positioning

Abstract

This study found that macular hole surgery with ILM peeling and a shortened period of face down positioning achieves excellent anatomical closure and is not associated with significant adverse outcomes.

25-Gauge Vitrectomy Using Sulfur Hexafluoride and No Prone Positioning for Repair of Macular Holes

“…[10][11][12] Several recent surgical series suggest that excellent outcomes can be achieved even with shorter duration of positioning or even without prone positioning. [13][14][15][16] To our knowledge, series describing results of macular hole repair without prone positioning or 25-gauge vitrectomy used C 3 F 8 or C 2 F 6 endotamponade. [17][18][19][20][21][22] In the current study, we evaluated macular hole closure rates, visual outcomes, and complications for a consecutive series of patients who underwent 25-gauge pars plana vitrectomy using SF 6 as a tamponade agent and who were not required to remain in a prone position.…”

Optical Coherence Tomography–guided Facedown Positioning for Macular Hole Surgery

“…3–5,7,9,10,12,19,27,28 Although OCT has become a vital tool in the evaluation and management of macular disease, its utility with macular hole surgery in the immediate postoperative period was originally limited by the interfering reflections of the gas bubble. Recent studies indicate the ability to show early macular hole closure on OCT through a gas bubble, 10–12 and data from our group indicate the consistent ability to image the macula through an intraocular gas bubble with a variety of SD-OCT machines, some more successful than others.…”

“…Prolonged facedown posturing is not only an inconvenience but also imposes physical, mental, and medical risks that can be a major burden for patients who are elderly. Although many have recommended <1 week or even no posturing, 3–9 some surgeons continue to use up to 1 week of posturing facedown arbitrarily. It may be beneficial to be able to use spectral domain optical coherence tomography (SD-OCT) to guide the decision-making process.…”

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…2, 3 Tornambe et al first addressed the lack of need for a facedown posturing, and other studies suggested a shortening of the posturing period. [4][5][6][7][8][9][10][11] A recent, multicenter randomized controlled study showed that the MH closure rate without facedown posturing was 90% for small idiopathic MHs. 12 Despite these improvements, there are still concerns that a shorter duration of posturing might lead to failure in some eyes.…”