Outcomes of macular hole surgery and shortened face down positioning.

Abstract

Internal limiting membrane (ILM) peeling in macular hole surgery may allow a shortened period of face down positioning. This study reports the results of macular hole surgery combined with shortened (3-day) face down positioning. The study was a retrospective review of data for 21 patients (21 eyes) treated for a macular hole by a single surgeon (G.K.S.). All patients underwent standard 3-port pars plana vitrectomy with triamcinolone-assisted ILM peeling and gas tamponade with 16% C3F8 or 25% SF6. Patients were instructed to remain in a face down position for 3 days at least 8 hours a day and to avoid flat on back positioning. The main outcome of anatomical closure was achieved in 20 (95%) of 21 eyes. Snellen visual acuity improved >2 lines in 76% (16/21) of patients. No patient lost >1 line of Snellen visual acuity. Two patients had postoperative increased (>24 mmHg) intraocular pressure that was successfully treated with pressure-lowering drops. Initial surgery failed to achieve hole closure in one patient, but with a second surgery and similar face down positioning, the hole was closed. This study found that macular hole surgery with ILM peeling and a shortened period of face down positioning achieves excellent anatomical closure and is not associated with significant adverse outcomes.