Dynamics of the macular hole-silicone oil tamponade interface with patient positioning as imaged by spectral domain-optical coherence tomography.
OBJECTIVE
The purposes of this study were to evaluate with spectral domain-optical coherence tomography the relationship between the retina and overlying silicone oil tamponade after macular hole surgery and to evaluate how this relationship changes with patient positioning.


METHODS
We studied a retrospective consecutive case series of 10 eyes from 9 patients who underwent macular hole surgery with silicone oil tamponade and subsequent spectral domain-optical coherence tomography scans. Four of the included eyes were also imaged with patients in face-down posture to determine whether the silicone-retina apposition changes with prone positioning. Finally, a single patient was also scanned in the lateral and supine positions.


RESULTS
The posterior surface of the silicone oil bubble was well visualized in all 10 eyes. In the majority of eyes (7 of 10), the oil tamponade bridged the macular hole, creating a prefoveal fluid space, but in 3 eyes the silicone oil filled the macular hole and was seen in touch with the underlying foveal depression or retinal pigment epithelium. In 75% of eyes (3 of 4), the silicone oil-retinal approximation did not vary with face-down position. Supine positioning clearly floated the silicone tamponade anteriorly and off the retinal surface.


CONCLUSIONS
Silicone oil tamponade can either bridge macular holes or, in a novel finding, fill the underlying foveal depression or macular hole space. Generally, the oil position is stable between face-forward and prone spectral-domain optical coherence tomography images, suggesting that either of these patient positions allows waterproofing of the underlying macular hole. Finally, our images confirm that supine positioning should be avoided postoperatively because it leads to loss of oil-retinal tamponade.
Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla, California 92103, USA.
Stephen F
SF
Oster
Francesca
F
Mojana
Dirk-Uwe G
DU
Bartsch
Michael
M
Goldbaum
William R
WR
Freeman
D000368:Aged; D006801:Humans; D008875:Middle Aged; D056888:Patient Positioning; D016684:Prone Position; D012160:Retina / Q000473:pathology; D012167:Retinal Perforations / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D012827:Silicone Oils / Q000008:administration & dosage*; D016683:Supine Position; D041623:Tomography, Optical Coherence; D014821:Vitrectomy
D012827:Silicone Oils