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 non-comparative 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 post-operatively 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.

Conclusions: There is a high rate of anatomical and functional success in patients undergoing macular hole surgery without prone posturing. In our study, most patients preferred long-acting gas tamponade with no posturing over the option of posturing with short-acting gas tamponade.