Outcomes of macular hole surgery and shortened face down positioning.
OBJECTIVE
Internal limiting membrane (ILM) peeling in macular hole surgery may allow a shortened period of face down positioning. This study reports the results of macular hole surgery combined with shortened (3-day) face down positioning.


METHODS
The study was a retrospective review of data for 21 patients (21 eyes) treated for a macular hole by a single surgeon (G.K.S.). All patients underwent standard 3-port pars plana vitrectomy with triamcinolone-assisted ILM peeling and gas tamponade with 16% C3F8 or 25% SF6. Patients were instructed to remain in a face down position for 3 days at least 8 hours a day and to avoid flat on back positioning.


RESULTS
The main outcome of anatomical closure was achieved in 20 (95%) of 21 eyes. Snellen visual acuity improved >2 lines in 76% (16/21) of patients. No patient lost >1 line of Snellen visual acuity. Two patients had postoperative increased (>24 mmHg) intraocular pressure that was successfully treated with pressure-lowering drops. Initial surgery failed to achieve hole closure in one patient, but with a second surgery and similar face down positioning, the hole was closed.


CONCLUSIONS
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.
Wickens
Jason C
JC
Washington University School of Medicine, St. Louis, Missouri, USA.
Shah
Gaurav K
GK
D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012167:Retinal Perforations / Q000601:surgery*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide; D014821:Vitrectomy
D005466:Fluorocarbons; C042852:perflutren; D014222:Triamcinolone Acetonide; D013459:Sulfur Hexafluoride