J Korean Ophthalmol Soc.  2015 Nov;56(11):1752-1758. 10.3341/jkos.2015.56.11.1752.

Surgical Outcomes of Taking a Reading Position after Air Tamponade in Idiopathic Macular Hole

• Kwon YK
• Eum SJ
• Shin JP
• Kim IT
• Park DH

• KMID: 2214184
• DOI: http://doi.org/10.3341/jkos.2015.56.11.1752

Abstract

PURPOSE
In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after receiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole.
METHODS
This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I assumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared between the 2 groups 6 months postoperatively.
RESULTS
The preoperative mean macular hole size was 456.2 +/- 164.1 microm in Group I and 411.2 +/- 105.7 microm in Group II and the differences between the 2 groups were not statistically significant (p = 0.647). At 6 months after surgery, the macular hole closure rate was 93% in Group I and 100% in Group II (p = 0.571) and the BCVA (log MAR) was 0.82 +/- 0.29 preoperatively and 0.92 +/- 0.35 postoperatively in Group I and 0.71 +/- 0.39 and 0.97 +/- 0.33 in Group II, respectively. The differences between the 2 groups (p = 0.09, p = 0.058) were not statistically significant (p = 0.809, p = 0.267).
CONCLUSIONS
There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in patients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.

Keyword

Air tamponade; Macular hole; No prone position; Reading position

MeSH Terms

Humans
Membranes
Retinal Perforations*
Visual Acuity
Vitrectomy

Figure

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  Figure 1. Spectral-domain optical coherence tomography (SD-OCT) images after macular hole surgery obtained from case 18. (A) Initial examination. SD-OCT demonstrated full thickness macular hole in left eye, minimum macular hole diameter is 326 μ m and basal diameter is 772 μ m. Preoperative stage showing stage 2 macular hole. Several intraretinal cysts are found in the perifoveal retina. (B) 1 day af-ter surgery, SD-OCT obtained through the air bubble shows resolution of the foveal cysts and macular hole was anatomically closed in left eye by the tissue including the ELM across the macular hole. (C) 2 days after surgery, Inner segment/outer segment (IS/OS) junction defect are present (arrow). (D) 7 days after surgery, macular hole is closed with foveal depression and IS/OS junction defect are still present apparently (arrowhead). Foveal lesion is more depressed than postoperative day 1. ELM = ex-ternal limiting membrane; Postop = postoperative.

Reference

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