Abstract

DO.04.06

Macular hole surgery: Is air as a short-time tamponade sufficient?

Caroline Gesser, Ute Porkert, Tillmann Eckert, Ute Eckardt, Claus Eckardt
Augenklinik, Städtische Kliniken Frankfurt-Höchst, Frankfurt/Main

Objective
We used a specially designed optical coherence tomography (OCT) device to investigate the dynamics of early macular hole closure after vitrectomy with air tamponade and to determine the closure rate and the briefest possible prone positioning.
Methods
112 patients with macular holes were examined using a modified spectral-domain OCT on days 1, 2 and 3 after vitrectomy with air tamponade. As soon as closure was complete (group one) or partial (hole closed at inner retinal layers but outer retinal layers still detached from pigment epithelial layer; group two), prone positioning was ended. If neither partial nor complete closure was observed by the 3rd day, renewed vitrectomy was performed on days 4 to 8 postoperative.
Results
Macular hole closure was achieved in 88 of the 112 eyes (79%). In 35 of the 88 eyes partial closure was noted on the first postoperative day. In 20 of the 24 eyes requiring renewed surgery the hole was finally closed. After a median follow up of 144 days the macular hole was completely closed in all layers in 108 patients (96%). Mean visual acuity at final follow up was 0.37 logMAR in group one, 0.29 logMAR in group two and 0.51 logMAR in patients whose holes closed after renewed surgery. Once closed, none of the macular holes reopened.
Conclusions
The 79% initial closure rate in the present study is about 10% lower than that reported in other studies employing long–acting gas tamponades. However, renewed surgery with air tamponade achieved a closure rate of 96%. Early partial closure is sufficient for subsequent complete closure, requires no further tamponade or prolonged prone positioning, and has no negative effect on the functional results. Short-term prone positioning is sufficient for most patients.

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