Macular hole surgery without postoperative prone position and spectral-domain optical coherence tomography imaging in gas-filled eyes

Abstract

Background: To evaluate whether spectral-domain optical coherence tomography (SD-OCT) can be used to determine if macular hole (MH) closure occurred in gas-filled eyes without postoperative face-down positioning.

Design: Interventional case series, university hospital setting.

Participants: We included 19 eyes of 19 MH patients who underwent vitrectomy with SF₆ gas tamponade without postoperative face-down positioning.

Methods: Vitrectomy with SF₆ gas tamponade was performed for MH without face-down positioning.  The MHs of all patients were evaluated using SD-OCT before and at 3 hours after surgery; daily until confirming the MH status; and at 1 and 3 months postoperatively.

Main Outcome Measures: Detection of MH closure.

Results: Three hours after surgery, no interpretable images were obtained for any of the 19 eyes.  On postoperative day (POD) 1, sufficiently clear images were obtained by SD-OCT to determine MH closure in 10 eyes, 16 eyes on POD 2, and 18 eyes on POD 3.  Clear images of the remaining eye were not obtained until POD 5, likely due to pupillary capture of the intraocular lens.  All MHs closed after the first surgery.

Conclusions: Hole closure can be precisely determined by POD 5 using SD-OCT.  If SD-OCT images through gas reveal that the hole is still open, then face-down positioning should be used so that residual gas in the vitreous cavity can close the hole, or a second vitrectomy should be planned.