Macular hole surgery with internal limiting membrane removal, air tamponade, and 1-day prone positioning

Abstract

Purpose: The internal limiting membrane (ILM) removal has been combined with macular hole surgery in recent years, which facilitates shortening of the prone-positioning period after surgery. In this study, surgical outcome of macular hole surgery with ILM removal, air tamponade, and 1-day prone positioning was evaluated.

Methods: In a prospective study, 23 patients (23 eyes) underwent vitrectomy for idiopathic macular holes. Macular holes <0.4 disc diameter and without apparent atrophy of retinal pigment epithelium (RPE) were selected for study. After vitrectomy combined with the ILM removal and fluid-air exchange, patients were instructed to keep prone positioning for only 1 day. The initial hole-closure rate, complications and visual outcome were evaluated.

Results: Anatomical closure of macular holes was achieved in 21 (91.3%) of the 23 eyes by one operation. The postoperative visual acuity of 0.5 or better and 1.0 were achieved in 19 eyes (82.6%) and 6 eyes (26.1%), respectively. Postoperatively, intraocular pressure was elevated temporarily in 2 eyes (8.7%); retinal break and posterior synechia occurred in 1 eye (4.3%) each. These complications were treated successfully and did not threaten visual acuity.

Conclusion: Air tamponade with ILM removal followed by 1-day prone positioning was considered to be a useful method for macular holes with small diameter and without apparent atrophy of RPE. This method facilitated early recovery to a normal social life.