Functional outcome and patient preferences following combined phaco-vitrectomy for macular hole without prone posturing

Abstract

Background Macular hole surgery varies widely regarding the duration of gas tamponade, the use of patient posturing post-operatively, and whether or not cataract extraction is undertaken at the same time. Aim To analyse anatomical and functional success rate following macular hole surgery and to examine patient preferences regarding posturing and length of gas tamponade. Materials and methods Study design.Prospective, interventional and noncomparative case series. Participants. Thirty patients with stage III and IV full-thickness macular hole who underwent macular hole repair during the period April 2005-January 2006. Intervention. All eyes underwent a standard three-port pars plana vitrectomy, removal of posterior vitreous, internal limiting membrane (ILM) peel, C3F8 gas tamponade, and cataract extraction with IOL implantation. Patients did not posture post-operatively. Outcome measures. Post-operative anatomic results, visual acuity, complications, patient preferences regarding surgical protocol, and subjective improvement in visual function. Results Patients were followed up postoperatively for 6 months. Primary anatomical hole closure was achieved in 96.7% eyes. Visual acuity improved in 83.8% patients. Two patients had raised intraocular pressure following surgery. A total of 96.9% of patients were happy with no posturing and a 2-month gas bubble.

Posturing after Macular Hole Surgery: A Review

“…Unsurprisingly, patients prefer not to undergo FDP [46]. Furthermore, compliance with FDP is poor [47].…”

Combined 23-gauge, sutureless transconjunctival vitrectomy with phacoemulsification without face down posturing for the repair of idiopathic macular holes

“…Since then, numerous reports pervade the ophthalmic literature, questioning the need for such posturing. [2][3][4][5][6][7] In this paper, we present the results of patients who underwent combined, sutureless vitrectomy, phacoemulsification, internal limiting membrane (ILM) peeling, and gas tamponade to ameliorate the signs and symptoms of idiopathic macular hole.…”

Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole

“…4,5 The initial descriptions of macular hole surgery required the patient to assume a face-down posture continuously for a minimum of 1 week. However, this is uncomfortable and inconvenient, and can be associated with complications such as ulnar nerve compression 6 and angle closure glaucoma.…”