Optical coherence tomography-guided facedown positioning for macular hole surgery.
OBJECTIVE
To use spectral domain optical coherence tomography-guided duration of facedown positioning to study anatomical macular hole closure rates.


METHODS
Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate.


RESULTS
There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days.


CONCLUSIONS
Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.
New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA. shahsp1@gmail.com
Sumit P
SP
Shah
Varsha
V
Manjunath
Adam H
AH
Rogers
Caroline R
CR
Baumal
Elias
E
Reichel
Jay S
JS
Duker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058450:Endotamponade; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D016684:Prone Position; D012167:Retinal Perforations / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014821:Vitrectomy; D014945:Wound Healing / Q000502:physiology
D005466:Fluorocarbons; C042852:perflutren; D013459:Sulfur Hexafluoride