Vitrectomy without postoperative posturing for idiopathic macular holes

To determine the success of vitrectomy with ILM peeling and C(3)F(8) tamponade for macular holes without the need for postoperative face-down posturing.

Twenty-four eyes of 24 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and C(3)F(8) tamponade without prone posturing were included in the study. All patients had follow up on 1 day, 2 weeks and 3 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre- and postoperatively.

Of the 24 eyes recruited, two (8%) had stage II, 17 (71%) had stage III and five (21%) had stage IV macular holes. Nineteen (79%) eyes were phakic and five (21%) eyes were pseudophakic at the time of surgery. The macular holes had been present for an average of 7.5 months (range 3-18 months). At 3-month follow up, 22/24 (91.6%) holes were closed. Both of the two holes that failed to close were stage IV macular holes. Preoperative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Postoperative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Eighteen eyes had improvement of visual acuity of at least one line on the Snellen chart, six eyes had no improvement. No eyes had worse vision postoperatively.

Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing.