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Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning
David R P Almeida1, Jonathon Wong, Michel Belliveau
1Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada. dalmeida@evolation-medical.com
Purpose:
The role of face-down posturing after macular hole (MH) surgery remains unclear and controversial. We evaluated the anatomical and visual outcomes of MH repair using a short duration (3 days) of prone positioning.
Methods:
Prospective series of 50 consecutive eyes in 50 patients with Stage 2 or Stage 3 idiopathic MHs. All eyes underwent vitrectomy MH surgery with internal limiting membrane peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, MH closure rates, complications, and postoperative visual acuity were investigated.
Results:
Anatomical closure of MHs was achieved in 49 (98%) of 50 eyes by 1 surgery. Postoperative logarithm of the minimum angle of resolution visual acuity decreased (i.e., improved) by 0.271 (95% confidence interval, 0.101-0.441 [P = 0.0024]). One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure fluctuations.
Conclusion:
Vitrectomy with internal limiting membrane peeling and gas tamponade with SF6 followed by short-duration 3-day face-down positioning is a successful surgical intervention for Stage 2 and Stage 3 idiopathic MHs. This method possessed minimal complications and offered significant improvement in visual acuity.
Insights
Short-term, 3-day face-down positioning after macular hole surgery is effective. This method achieved high closure rates and improved vision with minimal complications for idiopathic macular holes.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- The optimal duration of face-down positioning after macular hole surgery is debated.
- Previous studies suggest longer durations, but evidence for shorter periods is emerging.
Purpose of the Study:
- To evaluate the efficacy of a short, 3-day face-down positioning protocol after macular hole surgery.
- To assess anatomical and visual outcomes following this minimally invasive approach.
Main Methods:
- Prospective study of 50 patients with Stage 2 or 3 idiopathic macular holes.
- All patients underwent vitrectomy with internal limiting membrane peeling and SF6 gas tamponade.
- Combined cataract surgery was performed in phakic eyes; a 3-day prone positioning regimen was followed.
Main Results:
- Macular hole closure was achieved in 98% of eyes after a single surgery.
- A statistically significant improvement in visual acuity was observed (0.271 LogMAR).
- Complications were minimal, including one case each of pupillary capture and cystoid macular edema, with no IOP-related issues.
Conclusions:
- A 3-day face-down positioning protocol is a successful and safe surgical intervention for idiopathic macular holes.
- This short-duration prone positioning offers significant visual acuity improvement.
- The technique demonstrates a favorable safety profile with low complication rates.
