Optical coherence tomography-guided facedown positioning for macular hole surgery

Abstract

Purpose: To use spectral domain optical coherence tomography-guided duration of facedown positioning to study anatomical macular hole closure rates.

Methods: Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate.

Results: There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days.

Conclusion: Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Fig. 1

Study algorithm used to guide duration of facedown positioning. POD, postoperative day.

Fig. 2

Data summary of patients undergoing 3-day prone positioning. POD, postoperative day.

Fig. 3

Data summary of patients undergoing 7-day prone positioning. POD, postoperative day.

Fig. 4

Representative example, 3 days facedown, Case 1. A. Pre-operative SD-OCT. B. Postoperative Day 1 SD-OCT through complete intraocular gas endotamponade. C. Postoperative Week 1 SD-OCT. D. Postoperative Month 6 SD-OCT.

Fig. 5

Representative example, 7 days facedown, Case 2. A. Pre-operative SD-OCT. B. Postoperative Day 1 SD-OCT through complete intraocular gas endotamponade. C. Postoperative Month 1 SD-OCT. D. Postoperative Month 6 SD-OCT.

Fig. 6

Patient 32. A. Postoperative Day 1 image through intraocular gas bubble, suggesting closure of the macular hole. B. Postoperative Week 1 image revealing open macular hole. Inset: fundus rendered image showing <50% gas bubble. C. Postoperative Month 1 image showing closure of macular hole after supplemental intraocular gas and 1 additional week of facedown positioning.