[Significance of postoperative face-down positioning after surgery for idiopathic macular holes: consecutive case-control study].
BACKGROUND
Postoperative face-down positioning is considered to be a critical part in macular hole surgery with short-acting gas. However, the significance of this posturing remains uncertain using long-acting gas tamponade.


METHODS
Fifty consecutive eyes with idiopathic full-thickness macular holes underwent macular hole surgery with a follow up time of 6-12 months. The results of a cohort (25 eyes) with complete C3F8 (16%) vitreous fill without posturing was compared to a cohort (25 eyes) with SF6 (20%) with strict postoperative face-down positioning for two weeks.


RESULTS
With SF6 tamponade the anatomic success rate was 64% in the C3F8 cohort a complete closure was achieved in 88%. In the SF6 cohort, visual recovery of three lines or better was attained in 44%, resulting in a visual acuity of 20/50 or better in 12%. The mean postoperative visual acuity was 20/125 with a mean rise of 1.4 lines. In the C3F8 cohort, 72% improved for at least three lines with a mean postoperative visual acuity of 20/63 and a mean visual recovery of 3.3 lines. Visual acuity of 20/50 or better was noted in 48% of eyes.


CONCLUSIONS
The significantly higher success rate using C3F8 tamponade without positioning compared to SF6 gas tamponade with positioning confirms the cumulative tamponade duration being a crucial factor in macular hole surgery. Using a tamponade with short-acting gas only strict postoperative positioning ensures the contact of the gas bubble with foveal tissue and gains significance with reducing bubble size. While a potential for significant visual recovery in certain cases is evident, all in all a broad variability of the postoperative success rate can be stated. In contrast, even in supine position C3F8 attains a continuous tamponade enforcing a sufficient glial wound healing without any positioning.
Szurman
P
P
Universitäts-Augenklinik Köln, Joseph-Stelzmann-Str. 9, Köln.
Di Tizio
F M
FM
Lafaut
B
B
Aisenbrey
S
S
Grisanti
S
S
Roters
S
S
Bartz-Schmidt
K U
KU
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use*; D005499:Folliculitis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011182:Postoperative Care; D016684:Prone Position; D012167:Retinal Perforations / Q000601:surgery*; D013459:Sulfur Hexafluoride / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D005466:Fluorocarbons; C042852:perflutren; D013459:Sulfur Hexafluoride
Stellenwert der postoperativen Positionierung in der Chirurgie des idiopathischen Makulaforamens--Kontrollierte konsekutive Studie.