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Observational Study
. 2020 Sep-Oct;83(5):361-365.
doi: 10.5935/0004-2749.20200044.

Surgical results regarding the correction of macular hole with and without face-down posturing using 25% SF6 gas: a retrospective case series

Andre Luis Carvalho de Moura Bastos  1 , Marcos Pereira de Ávila  2 , David Leonardo Cruvinel Isaac  2 , Levy Paz Aguiar  1 , Aline Guerreiro Aguiar  1
Affiliations
Observational Study

Surgical results regarding the correction of macular hole with and without face-down posturing using 25% SF6 gas: a retrospective case series

Andre Luis Carvalho de Moura Bastos et al. Arq Bras Oftalmol. 2020 Sep-Oct.

Abstract
in English, Portuguese

Purpose: This study aims to compare the anatomical success rates of vitrectomy and SF6 gas tamponade for macular hole surgery with and without postoperative face-down posturing.

Methods: This was an observational, longitudinal, and retrospective case series analysis. The study included 52 eyes from 52 patients who underwent pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and 25% SF6 tamponade for stages 2, 3, and 4 macular holes. After surgery, all patients were provided with a postoperative postural regimen: 31 patients were instructed not to maintain face-down posturing, whereas 21 were instructed to maintain face-down posturing for 7 days. The primary outcome measure was the macular hole closure rate. Statistical analysis was performed using Epi Info 7.1.

Results: A total of 47 (90.3%) patients achieved hole closure. The nonface-down posturing group and face-down posturing group obtained closure rates of 90.3% and 90.4%, respectively; these rates were not significantly different. Statistical analysis revealed that no significant differences existed in sex, age, hole duration, hole stage, preoperative visual acuity, or postoperative visual acuity between the two groups.

Conclusion: Our results suggest that macular hole surgery with the use of short duration gas (SF6) is safe and effective and that maintaining a postural orientation of nonface-down posturing is also safe. However, these recommendations should be assessed further in a prospective and randomized study to comprehensively delineate the associated benefits and risks.

Objetivos: Comparar as taxas de sucesso anatômico da vitrectomia e tamponamento de gás SF6 na cirurgia de buraco macular com e sem a postura pronada pós-operatória.

Métodos: Foi realizado um estudo observacional, longitudinal e retrospectivo de séries de casos. O estudo incluiu 52 olhos de 52 pacientes submetidos à vitrectomia posterior via pars-plana com peeling de membrana limitante interna auxiliada por azul trypan e tamponamento com gás SF6 a 25% para os estágios 2, 3 e 4 dos buracos maculares. Após a cirurgia, todos os pacientes foram orientados a manter um regime postural pós-operatório: 31 pacientes foram orientados a não realizar posição pronada de cabeça, enquanto 21 foram orientados a manter uma pronada pós-operatória por 7 dias. O objetivo principal foi a análise da taxa de fechamento do buraco macular. A análise estatística foi realizada usando Epi-Info 7.1.

Resultados: Um total de 47 (90,3%) pacientes obtiveram fechamento do buraco macular. O grupo de postura não pronada e o grupo de postura pronada obtiveram taxas de fechamento de 90,3%, e 90,4%, respectivamente; essas taxas não foram significativamente diferentes. A análise estatística revelou que não houve diferenças significativas relacionadas ao gênero, idade, duração do buraco macular, estágio do buraco macular, acuidade visual corrigida pré e pós-operatória entre os dois grupos.

Conclusão: Nossos resultados sugerem que a cirurgia para buraco macular com o uso de gás de curta duração (SF6) é segura e eficaz e que a manutenção de uma orientação pós-operatória de não-pronada também é segura. No entanto, essas recomendações devem ser avaliadas em um estudo prospectivo e randomizado para delinear de forma abrangente os riscos e benefícios associados.

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Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Spectral domain OCT images of patients before surgery (A, C, E, G) and 30 days after surgery (B, D, F, H). Representative patients: a 66-year-old woman from the non-FDP group (A and B) with an initial BCVA of 20/200 and postoperative BCVA of 20/100, a 71-year-old woman from the non-FDP group (C and D) with an initial BCVA of 20/400 and postoperative BCVA of 20/80, a 62-year-old woman from the FDP group (E and F) with an initial BCVA of 20/200 and postoperative BCVA of 20/60, and a 62-year-old woman from the FDP group (G and H) with an initial BCVA of 20/400 and postoperative BCVA of 20/80.
See this image and copyright information in PMC

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