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Surgery for full-thickness macular holes with short-duration prone posturing: results of a pilot study
J D Ellis1, T Y Malik, M A Taubert
1Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, Scotland, UK. ellisfamily@14bing.freeserve.co.uk
Purpose:
To see whether surgical success and complication rates in surgery for full-thickness macular holes (FTMH) followed by 5 days prone posturing are comparable to those obtained with longer posturing regimes recorded in the literature.
Methods:
A pilot study was carried out of pars plana vitrectomy, autologous platelet adjunct and 16% C2F6 tamponade followed by 5 days prone posturing in 38 eyes of 34 patients with idiopathic FTMH. A follow-up postal questionnaire was used to assess patients' perception of posturing and outcome.
Results:
Fifty-three per cent of eyes gained 2 or more lines of Snellen acuity. Twenty-four per cent of patients with symptom duration of 12 months or less (29 patients) achieved a visual acuity of 6/12. Fifty-eight per cent of patients achieved N8 or better near vision. The only significant predictor of post-operative Snellen acuity was the stage of the hole (p = 0.02). Eighty-six per cent of questionnaire respondents felt that surgery had improved their quality of life. Eighty-seven per cent of all patients reported a reduction in, or elimination of, metamorphopsia. Fifty-four per cent of patients described posturing for 5 days as difficult or very difficult. Five patients admitted to posturing for less than 12 h a day, but all stated that they had postured for the full 5 days. Cataract was the commonest complication observed in this series (42% of patients have had or been listed for cataract surgery).
Conclusions:
Five days of prone posturing following vitrectomy for FTMH with autologous plaletet concentrate and C2F6 tamponade afforded success and complication rates comparable to those in published studies with longer posturing times.
Insights
Short-term prone posturing after vitrectomy for full-thickness macular holes (FTMH) shows comparable surgical success and complication rates to longer durations. This approach improves visual acuity and quality of life for FTMH patients.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- Full-thickness macular holes (FTMH) are a common cause of visual impairment.
- Current surgical management often involves prolonged prone posturing, which can be burdensome for patients.
Purpose of the Study:
- To evaluate the efficacy and safety of a shortened 5-day prone posturing regimen after vitrectomy for FTMH.
- To compare surgical outcomes and complication rates with longer posturing durations reported in existing literature.
Main Methods:
- A pilot study involving 38 eyes of 34 patients with idiopathic FTMH.
- Pars plana vitrectomy with autologous platelet adjunct and C2F6 tamponade, followed by 5 days of prone posturing.
- Patient-reported outcomes and visual acuity were assessed via a postal questionnaire.
Main Results:
- 53% of eyes gained 2 or more lines of Snellen acuity; 24% achieved 6/12 visual acuity with symptom duration ≤12 months.
- 87% reported reduced metamorphopsia; 86% felt surgery improved quality of life.
- Cataract was the most common complication (42%); 54% found 5-day posturing difficult, though compliance was high.
Conclusions:
- A 5-day prone posturing period is a viable alternative to longer regimens for FTMH surgery.
- This shorter duration yields comparable success and complication rates to established longer posturing protocols.
- The study highlights patient-reported benefits in vision and quality of life, despite challenges with posturing.