Functional outcome and patient preferences following combined phaco-vitrectomy for macular hole without prone posturing.
BACKGROUND
Macular hole surgery varies widely regarding the duration of gas tamponade, the use of patient posturing post-operatively, and whether or not cataract extraction is undertaken at the same time.


OBJECTIVE
To analyse anatomical and functional success rate following macular hole surgery and to examine patient preferences regarding posturing and length of gas tamponade.


METHODS
Study design. Prospective, interventional and non-comparative case series.


METHODS
Thirty patients with stage III and IV full-thickness macular hole who underwent macular hole repair during the period April 2005-January 2006.Intervention. All eyes underwent a standard three-port pars plana vitrectomy, removal of posterior vitreous, internal limiting membrane (ILM) peel, C3F8 gas tamponade, and cataract extraction with IOL implantation. Patients did not posture post-operatively.Outcome measures. Post-operative anatomic results, visual acuity, complications, patient preferences regarding surgical protocol, and subjective improvement in visual function.


RESULTS
Patients were followed up post-operatively for 6 months. Primary anatomical hole closure was achieved in 96.7% eyes. Visual acuity improved in 83.8% patients. Two patients had raised intraocular pressure following surgery. A total of 96.9% of patients were happy with no posturing and a 2-month gas bubble.


CONCLUSIONS
There is a high rate of anatomical and functional success in patients undergoing macular hole surgery without prone posturing. In our study, most patients preferred long-acting gas tamponade with no posturing over the option of posturing with short-acting gas tamponade.
Madgula
I M
IM
Hull and East Yorkshire Eye Hospital, Hull Royal Infirmary, Hull, North Humberside, UK. moorthyindira@yahoo.co.uk
Costen
M
M
D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018918:Phacoemulsification / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D016684:Prone Position; D011446:Prospective Studies; D012167:Retinal Perforations / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
D005466:Fluorocarbons; C042852:perflutren