Abstract
Purpose: To see whether surgical success and complication rates in surgery for full- thickness macular holes (FTMH) followed by 5 days prone posturing are comparable to those obtained with longer posturing regimes recorded in the literature.
Methods: A pilot study was carried out of pars plana vitrectomy, autologous platelet adjunct and 16% C2F6 tamponade followed by 5 days prone posturing in 38 eyes of 34 patients with idiopathic FTMH. A follow-up postal questionnaire was used to assess patients' perception of posturing and outcome.
Results: Fifty-three per cent of eyes gained 2 or more lines of Snellen acuity. Twenty-four per cent of patients with symptom duration of 12 months or less (29 patients) achieved a visual acuity of 6/12. Fifty-eight per cent of patients achieved N8 or better near vision. The only significant predictor of post-operative Snellen acuity was the stage of the hole (p = 0.02).
Eighty-six per cent of questionnaire respondents felt that surgery had improved their quality of life. Eighty-seven per cent of all patients reported a reduction in, or elimination of, metamorphopsia. Fifty-four per cent of patients described posturing for 5 days as difficult or very difficult. Five patients admitted to posturing for less than 12 h a day, but all stated that they had postured for the full 5 days. Cataract was the commonest complication observed in this series (42% of patients have had or been listed for cataract surgery).
Conclusions: Five days of prone posturing following vitrectomy for FTMH with autologous plaletet concentrate and C2F6 tamponade afforded success and complication rates comparable to those in published studies with longer posturing times.
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Smiddy WE, Pimentel S, Williams GA . Macular hole surgery without using adjunctive additives. Ophthalmic Surg Lasers 1997;28:713–7.
Goldbaum MH, McCuen BW, Hanneken AM, Burgess SK, Chen HH . Silicone oil tamponade to seal macular holes without position restrictions. Opthalmology 1998;105:2140–7; discussion 2147–8.
Tornambe PE, Poliner LS, Grote K . Macular hole surgery without face-down positioning: a pilot study. Retina 1997;17:179–85.
Kelly NE, Wendel RT . Vitreous surgery for idiopathic macular holes: results of a pilot study. Arch Ophthalmol 1991;109:654–9.
Poliner LS, Tornambe PE . Retinal pigment epitheliopathy after macular hole surgery. Ophthalmology 1992;99:1671–7.
Wendel RT, Patel AC, Kelly NE, Salzano TC, Wells JW, Novack GD . Vitreous surgery for macular holes. Ophthalmology 1993;100:1671–6.
Orellana J, Lieberman RM . Stage II macular hole surgery. Br J Ophthalmol 1993;77:555–8.
Ruby AJ, Williams DF, Grand MG, Thomas MA, Meredith TA, Boniuk I, et al. Pars plana vitrectomy for treatment of stage 2 macular holes. Arch Ophthalmol 1994;112:359–64.
Gaudric A, Massin P, Paques M, Santiago PY, Guez JE, Le Gargasson JF, et al. Autologous platelet concentrate for the treatment of full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol 1995;233:549–54.
Korobelnik JF, Hannouche D, Belayachi N, Branger M, Guez JE, Hoang-Xuan T. Autologous platelet concentrate as an adjunct in macular hole healing: a pilot study. Ophthalmology 1996;103:590–4.
Gaudric A, Paques M, Massin P, Santiago P, Dosquet C . of autologous platelet concentrate in macular hole surgery: report of 77 cases. Dev Ophthalmol 1997;29:30–5.
Wells JA, Gregor ZJ . Surgical treatment of full-thickness macular holes using autologous serum. Eye 1996;10:593–9.
Olsen TW, Sternberg P Jr, Capone A Jr, Martin DF, Lim JI, Grossniklaus HE, et al. Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane. Retina 1998;18:322–9.
Pearce IA, Branley M, Groenewald C, McGalliard J, Wong D . Visual function and patient satisfaction after macular hole surgery. Eye 1998;12:651–8.
Glaser BM, Michels RG, Kuppermann BD, Sjaarda RN, Pena RA . Transforming growth factor-132 for the treatment of full thickness macular holes. Ophthalmology 1992;99:1162–74.
Lansing MB, Glaser BM, Liss H, Hanham A, Thompson JT, Sjaarda RN, Gordon A . The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular holes. Ophthalmology 1993;100:868–71.
Minihan M, Goggin M, Cleary PE . Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2. Br J Ophthalmol 1997;81:1073–9.
Thompson JT, Smiddy WE, Glaser BM, Sjaarda RN, Flynn HW . Intraocular tamponade duration and success of macular hole surgery. Retina 1996;16:373–82.
Storz Ophthalmics. The days following macular hole surgery. Face down posturing, SPA-5618REV.7/96.3365 Tree Court Industrial Blvd, St Louis, MO, USA, 1996.
Ezra E, Arden GB, Riordan-Eva P, Aylward GW, Gregor ZJ . Visual field loss following vitrectomy for stage 2 and 3 macular holes. Br J Ophthalmol 1996;80:519–25.
Gass JDM . Idiopathic senile macular hole: its stages and pathogenesis. Arch Ophthalmol 1988;106:629–39.
Gass JDM . Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol 1995;119:752–9.
Watzke RC, Allen L . Subjective slit beam sign for macular disease. Am J Ophthalmol 1969;68:449.
Ducker JS, Wendel R, Patel AC, Puliafito CA . Late re-opening of macular holes after initially successful treatment with vitreous surgery. Ophthalmology 1994;101:1373–8.
Thompson JT, Glaser BM, Sjaarda RN, Murphy RP . Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes. Am J OphthalmoI 1995;119:48–54.
Paques M, Massin P, Santiago PY, Spielmartn AC, Le Gargasson JF, Gaudric A . Late reopening of successfully treated macular holes. Br J Ophthalmol 1997;81:658–62.
Yeo JH, Sadeghi J, Green R, Glaser BM . Intravenous fibronectin and platelet-derived growth factor. Arch Ophthalmol 1986;104:417–21.
Ryan EH, Gilbert HD . Results of surgical treatment of recent onset full-thickness idiopathic macular holes. Arch Ophthalmol 1995;113:822–3.
Smiddy WE, Glaser BM, Thompson JT, Sjaarda RN, Flynn HW Jr, Hanham A, et al. Transforming growth factor beta-2 significantly enhances the ability to flatten the rim of subretinal fluid surrounding macular holes: preliminary anatomic results of a multicenter prospective randomized study. Retina 1993;13:296–301.
Paques M, Chastang C, Mathis A, Sahel J, Massin P, Dosquet C, et al. Effect of autologous platelet concentrate in surgery for idiopathic macular hole: results of a multicenter, double-masked, randomized trial. Platelets in Macular Hole Surgery Group. Ophthalmology 1999;106:932–8.
Roth DB, Smiddy WE, Feuer W . Vitreous surgery for chronic macular holes. Ophthalmology 1997;104:2047–52.
Thompson JT, Sjaarda RN, Lansing MB . The results of vitreous surgery for chronic macular holes. Retina 1997;17:493–501.
Madreperla SA, Geiger GL, Funata M, de la Cruz Z, Greer WR . Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology 1994;101:682–6.
Funata MT, Wendel RT, De La Cruz Z, Green WR . Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina 1992;12:289–98.
Guyer DR, Green WR, de Bustros S, Fine SL . Histopathologic features of idiopathic macular holes and cysts. Ophthalmology 1990;97:1045–51.
Ezra E, Munro PM, Charteris DG, Aylward WG, Luthert PJ, Gregor ZJ . Macular hole opercula: ultrastructural features and clinicopathological correlation. Arch Ophthalmol 1997;115:1381–7.
Wong D, Groenewald C . Macular hole surgery. Continuing Med Educ J 1997;1:49–52.
Thompson JT, Glaser BM, Sjaarda RN, Murphy RP, Hanham A . Effects of intraocular bubble duration in the treatment of macular holes by vitrectomy and transforming growth factor-beta 2. Ophthalmology 1994;101:1195–200.
Schultz KF, Chalmers I, Hayes RJ, Altman DG . Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408–12.
Boldt HC, Munden PM, Folk JC, Mehaffey MG . Visual field defects after macular hole surgery. Am J Ophthalmol 1996;122:371–81.
Paques M, Massin P, Santiago PY, Spielman AC, Gaudric A . Visual field loss after vitrectomy for full-thickness macular holes. Am J Ophthalmol 1997;124:88–94.
Ezra E, Arden GB, Riordan-Eva P, Aylward GW, Gregor ZJ . Visual field loss following vitrectomy for stage 2 and 3 macular holes. Br J Ophthalmol 1996;80:519–25.
Welch JC . Dehydration injury as a possible cause of visual field defect after pars plana vitrectomy for macular hole. Am J Ophthalmol 1997;124:698–9.
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Presented at the Scottish Ophthalmological Club, October 1998
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Ellis, J., Malik, T., Taubert, M. et al. Surgery for full- thickness macular holes with short-duration prone posturing: Results of a pilot study. Eye 14, 307–312 (2000). https://doi.org/10.1038/eye.2000.78
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DOI: https://doi.org/10.1038/eye.2000.78
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