Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning

To evaluate the closure rate after macular hole surgery with air tamponade and face-down positioning whose duration is based on postoperative optical coherence tomography (OCT).

In a prospective study, data were gathered on 33 eyes of 33 consecutive patients undergoing macular hole surgery. Postoperatively, OCT images were obtained in a face-down position to minimize the interfering reflections created by the air bubble. The face-down positioning was ended as soon the OCT revealed closure of the hole.

Opacity of the media in 8/33 eyes 24 hours postoperatively precluded OCT. In 18/33 eyes (54.5%), the hole was closed on OCT 24 hours postoperatively and in 25/33 (75.7%), 48 hours postoperatively. In 4/33 eyes (12.1%), the hole was judged to be open on OCT 24 hours postoperatively. Despite continued face-down positioning, the hole had closed on the third day postoperatively in only one of these four eyes. In two of the remaining three eyes, the macular hole could be closed by a second surgery which was performed 5 to 6 days after the first vitrectomy. Using OCT monitoring, more than half (54%) of our patients could quit the face-down position after 24 hours, 21% after 48 hours, and 24% after 3 days.

Vitrectomy and air tamponade combined with 1- to 3-day face-down positioning produced an excellent rate of macular hole closure. Already on the first and second day postoperatively OCT on patients in a prone position enabled the monitoring of the progress of the macular hole closure through the air bubble. This method allows effective adjustment of the duration of face-down positioning based on OCT findings.