Macular hole repair outcomes with non-supine positioning

Transcription

1 Number of Patients Macular hole repair outcomes with non-supine positioning Jaafar El Annan, M.D., Jordan Heffez, M.D., Joshua D. Udoetuk, M.D., Menka M. Sanghvi, Petros E. Carvounis, M.D., F.R.C.S.C Retina Consultants DC, Washington, D.C. Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX BACKGROUND RESULTS 78 (1) Repair of macular hole (MH) has in the past required prone positioning in the early post-operative period following pars plana vitrectomy; There was no significant difference in anatomic success between phakic (34/36) and non-phakic (19/1 pseudophakic eyes and 1/1 aphakic eye) eyes (p=.99). 1 The requirement for prone positioning has been questioned; 1 Indeed, multiple case series suggest that non-supine The overall macular hole closure rate was 93.% in the 8 positioning results in similar anatomic success rates as prone positioning; eyes of the 4 patients included. Stage II Stage III Stage IV Randomized controlled studies have also shown that for small macular holes the results are similar with non-supine compared to prone positioning; However, most vitreoretinal surgeons in the U.S. still instruct their patients to maintain prone positioning in the early postoperative period; Moreover, it has been suggested that this may not be true in phakic patients; supposedly the gas bubble is smaller in phakic patients and this does not allow adequate coverage of the macular hole; Finally, case series using non-supine positioning commonly use perfluoropropane (C3F8) for endotamponade. OBJECTIVES To compare macular hole closure rates between phakic and non-phakic patients following sulfur hexafluoride (SF6) endotamponade and nonsupine positioning. METHODS BACKGROUND Retrospective, interventional, case series of consecutive patients who underwent vitrectomy with internal limiting membrane peel for macular hole repair using SF6 and nonsupine positioning postoperatively between August 7 and December 1. Excluded were patients who had inadequate gas-fill on the first post-operative day and who were asked to do prone positioning. Rate of closure was 1% for stage II ( of ), 86% for stage III (1 of 14), 91% for stage IV ( of ). BCVA siginificantly improved from.76 logmar (/1) preop to.33 logmar (/4) at the last visit (p<.). Final visual acuity > /4 in 67% and > / in 4% of eyes. We did not identify any variables associated with increased failure rate Phakic Non-Phakic Table 1. Summary of Macular Hole Closure Outcomes After Single Surgery Without Prone Positioning Table. Summary of Macular Hole Closure Outcomes After Single Surgery Depending on the Hole Stage CONCLUSIONS CONCLUSIONS Macular hole repair with non-supine positioning: Has similar closure rates between phakic and non-phakic patients; Has a high success rate using SF6; Has a high success rate using triamcinolone acetonide as an aid for the ILM peel. REFERENCES Nomoto H, Shiraga F, Yamaji H, Fukuda K, Baba T, Takasu I, Ohtsuki H. Macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling: one-year results. Retina. 8 Mar;8(3):47-3. Tornambe PE, Poliner LS, Grote K. Macular hole surgery without face-down positioning. A pilot study. Retina. 1997;17(3): Solebo AL, Lange CA, Bunce C, Bainbridge JW. Face-down positioning or posturing after macular hole surgery. Cochrane Database Syst Rev. 11 Dec 7;(1):CD88 Tatham A, Banerjee S. Face-down posturing after macular hole surgery: a metaanalysis. Br J Ophthalmol. 1 May;94(): Kim SS, Smiddy WE, Feuer WJ, Shi W. Outcomes of sulfur hexafluoride (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgery. Retina. 8 Nov- Dec;8(1):148-. ACKNOLEDGEMENTS Unrestricted grant from Research to Prevent Blindness

2 Retrospective interventional case series Consecutive patients who underwent small gauge vitrectomy for macular hole repair with non-supine positioning postoperatively between August 7 and December 1. Excluded were patients who had inadequate gas-fill on the first post-operative day and who were asked to do prone positioning.

3 The overall macular hole closure rate was 93.% in the 9 eyes of the 4 patients included. Rate of closure was 1% for stage II ( of ), 86% for stage III (1 of 14), 91% for stage IV ( of ). BCVA siginificantly improved from.76 logmar (/1) preop to.33 logmar (/4) at the last visit (p<.). Final visual acuity > /4 in 67% and > / in 4% of eyes.

4 Phakic Non-Phakic Summary of Macular Hole Closure Rates After Single Surgery Without Prone Positioning

5 1 1 Stage II Stage III Stage IV Summary of Macular Hole Closure Outcomes After Single Surgery Depending on the Hole Stage

6 Macular hole closure rates with non-supine positioning is similar to previous reports with facedown positioning. Visual outcomes significantly improved by an average of 4 lines on ETDRS chart. We believe that our technique with nonsupine positioning for macular holes has excellent outcomes with less discomfort to patients.