No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes.

Abstract

OBJECTIVE:

To demonstrate the efficacy of broad internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes (MHs).

DESIGN:

Retrospective study.

PARTICIPANTS:

Sixty-eight idiopathic MH cases in 68 eyes of 65 patients.

METHODS:

All idiopathic MH surgeries by 1 surgeon between March 2009 and December 2012, performed using broad ILM peeling, 20% SF6, and no face-down positioning, were reviewed. No cases were excluded. Surgeon method included 23-gauge or 25-gauge pars plana vitrectomy with induction of posterior vitreous detachment (if necessary). Indocyanine green dye (0.08 mg/ml in D5W) was injected slowly, allowed to stain for 60 seconds, and then removed. The ILM was broadly peeled to the vascular arcades (approximately 8000 μm in diameter), followed by 2 fluid-air exchanges, separated by 5 minutes, and an air-20% SF6 exchange. Patients maintained reading position for 3 to 5 days and were followed up at least for 1 month. Exact binomial distributions were used to establish 95% confidence intervals, and the 1-way analysis of variance was used to compare preoperative and postoperative intraocular pressures (IOPs).

MAIN OUTCOME MEASURES:

Single-procedure MH closure rate, mean postoperative best-corrected visual acuity (BCVA), incidence of cataract, and IOP.

RESULTS:

Three patients (4.6%) had bilateral MH and 9 patients (13.8%) had recurrent MH (mean duration from previous surgery, 8.3 ± 5.5 years; range, 1-16 years). Twenty-one MH (30.9%) were stage 2, 27 (39.7%) were stage 3, and 20 (29.4%) were stage 4. Five MH had a basal diameter of more than 1000 μm. Mean MH basal diameter was 609.6 ± 226.2 μm. Mean preoperative BCVA was 0.68 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/95), and mean most recent postoperative BCVA was 0.28 ± 0.18 logMAR units (Snellen equivalent, 20/38). The single-procedure MH closure rate was 100% (95% confidence interval, 95%-100%), and no complications were observed.

CONCLUSIONS:

Macular hole surgery with broad ILM peeling, 20% SF6 gas, and no face-down positioning is highly effective in the surgical treatment of idiopathic MH with efficacy comparable with methods that use longer-acting gas endotamponade, face-down positioning, or both. In our series, this method eliminated the morbidity associated with postoperative face-down positioning.

FINANCIAL DISCLOSURE(S):

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

• Authors: Raymond Iezzi, Kapil G Kapoor
• Journal: Ophthalmology (Ophthalmology) Vol. 120 Issue 10 Pg. 1998-2003 (Oct 2013) ISSN: 1549-4713 [Electronic] United States
• PMID: 23890419 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Sulfur Hexafluoride

Topics

• Aged
• Endotamponade (methods)
• Epiretinal Membrane (surgery)
• Female
• Humans
• Intraocular Pressure (physiology)
• Macula Lutea (surgery)
• Male
• Middle Aged
• Patient Positioning (methods)
• Postoperative Care (methods)
• Prone Position
• Retinal Perforations (physiopathology, surgery)
• Retrospective Studies
• Sulfur Hexafluoride (administration & dosage)
• Visual Acuity (physiology)
• Vitrectomy (methods)