Abstract
AIMS—To investigate the role of phacovitrectomy surgery without prone posture for stage 2 and 3 macular holes. METHODS—A pilot study was performed on 20 patients (20 eyes) having phacoemulsification lens removal and vitrectomy surgery with 20% C2F6 tamponade. Patients were advised to avoid lying on their backs for 10 days following surgery but no other posturing instructions were given. Closure rates and improvement in visual acuity were compared with a group of historical controls in whom phacovitrectomy with gas tamponade and face down posturing was performed. RESULTS—Anatomical hole closure was noted in 18 of the 20 eyes (90%). 19 eyes (95%) showed an improvement of at least 0.3 logMAR units. This compares favourably with the postured group in which anatomical hole closure was noted in 11 of 13 eyes (85%) and nine of 13 eyes (69%) showed an improvement of at least 0.3 logMAR units. CONCLUSION—Combined surgery facilitates the use of a large gas bubble. Sufficient tamponade of the hole occurs for closure without prone posturing. Combined surgery prevents patients posturing and returning for cataract surgery.
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Selected References
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- Banker A. S., Freeman W. R., Kim J. W., Munguia D., Azen S. P. Vision-threatening complications of surgery for full-thickness macular holes. Vitrectomy for Macular Hole Study Group. Ophthalmology. 1997 Sep;104(9):1442–1453. doi: 10.1016/s0161-6420(97)30118-3. [DOI] [PubMed] [Google Scholar]
- Berger J. W., Brucker A. J. The magnitude of the bubble buoyant pressure: implications for macular hole surgery. Retina. 1998;18(1):84–88. doi: 10.1097/00006982-199801000-00020. [DOI] [PubMed] [Google Scholar]
- Brooks H. L., Jr Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology. 2000 Oct;107(10):1939–1949. doi: 10.1016/s0161-6420(00)00331-6. [DOI] [PubMed] [Google Scholar]
- Carter J. B., Michels R. G., Glaser B. M., De Bustros S. Iatrogenic retinal breaks complicating pars plana vitrectomy. Ophthalmology. 1990 Jul;97(7):848–854. doi: 10.1016/s0161-6420(90)32492-2. [DOI] [PubMed] [Google Scholar]
- Chang T. S., McGill E., Hay D. A., Ross W. H., Maberley A. L., Sibley L. M., Ma P. E., Potter M. J. Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole. Br J Ophthalmol. 1999 Aug;83(8):944–948. doi: 10.1136/bjo.83.8.944. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Demols P., Rasquin F., Schrooyen M. La chirurgie du trou maculaire sans positionnement. Bull Soc Belge Ophtalmol. 2000;275:57–61. [PubMed] [Google Scholar]
- Duker J. S., Wendel R., Patel A. C., Puliafito C. A. Late re-opening of macular holes after initially successful treatment with vitreous surgery. Ophthalmology. 1994 Aug;101(8):1373–1378. doi: 10.1016/s0161-6420(13)31174-9. [DOI] [PubMed] [Google Scholar]
- Díaz Lacalle V., Orbegozo Gárate F. J., Martinez Alday N., López Garrido J. A., Aramberri Agesta J. Phacoemulsification cataract surgery in vitrectomized eyes. J Cataract Refract Surg. 1998 Jun;24(6):806–809. doi: 10.1016/s0886-3350(98)80135-1. [DOI] [PubMed] [Google Scholar]
- Ellis J. D., Malik T. Y., Taubert M. A., Barr A., Baines P. S. Surgery for full-thickness macular holes with short-duration prone posturing: results of a pilot study. Eye (Lond) 2000 Jun;14(Pt 3A):307–312. doi: 10.1038/eye.2000.78. [DOI] [PubMed] [Google Scholar]
- Freeman W. R. Vitrectomy surgery for full-thickness macular holes. Am J Ophthalmol. 1993 Aug 15;116(2):233–235. doi: 10.1016/s0002-9394(14)71292-9. [DOI] [PubMed] [Google Scholar]
- Glaser B. M., Michels R. G., Kuppermann B. D., Sjaarda R. N., Pena R. A. Transforming growth factor-beta 2 for the treatment of full-thickness macular holes. A prospective randomized study. Ophthalmology. 1992 Jul;99(7):1162–1173. doi: 10.1016/s0161-6420(92)31837-8. [DOI] [PubMed] [Google Scholar]
- Goldbaum M. H., McCuen B. W., Hanneken A. M., Burgess S. K., Chen H. H. Silicone oil tamponade to seal macular holes without position restrictions. Ophthalmology. 1998 Nov;105(11):2140–2148. doi: 10.1016/S0161-6420(98)91140-X. [DOI] [PubMed] [Google Scholar]
- Grusha Y. O., Masket S., Miller K. M. Phacoemulsification and lens implantation after pars plana vitrectomy. Ophthalmology. 1998 Feb;105(2):287–294. doi: 10.1016/s0161-6420(98)93133-5. [DOI] [PubMed] [Google Scholar]
- Johnson R. N., Gass J. D. Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Ophthalmology. 1988 Jul;95(7):917–924. doi: 10.1016/s0161-6420(88)33075-7. [DOI] [PubMed] [Google Scholar]
- Kadonosono K., Itoh N., Uchio E., Nakamura S., Ohno S. Staining of internal limiting membrane in macular hole surgery. Arch Ophthalmol. 2000 Aug;118(8):1116–1118. doi: 10.1001/archopht.118.8.1116. [DOI] [PubMed] [Google Scholar]
- Kelly N. E., Wendel R. T. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991 May;109(5):654–659. doi: 10.1001/archopht.1991.01080050068031. [DOI] [PubMed] [Google Scholar]
- Kotecha A. V., Sinclair S. H., Gupta A. K., Tipperman R. Pars plana vitrectomy for macular holes combined with cataract extraction and lens implantation. Ophthalmic Surg Lasers. 2000 Sep-Oct;31(5):387–393. [PubMed] [Google Scholar]
- Lansing M. B., Glaser B. M., Liss H., Hanham A., Thompson J. T., Sjaarda R. N., Gordon A. J. The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular holes. Ophthalmology. 1993 Jun;100(6):868–872. doi: 10.1016/s0161-6420(93)31561-7. [DOI] [PubMed] [Google Scholar]
- Liggett P. E., Skolik D. S., Horio B., Saito Y., Alfaro V., Mieler W. Human autologous serum for the treatment of full-thickness macular holes. A preliminary study. Ophthalmology. 1995 Jul;102(7):1071–1076. doi: 10.1016/s0161-6420(95)30909-8. [DOI] [PubMed] [Google Scholar]
- Mester V., Kuhn F. Internal limiting membrane removal in the management of full-thickness macular holes. Am J Ophthalmol. 2000 Jun;129(6):769–777. doi: 10.1016/s0002-9394(00)00358-5. [DOI] [PubMed] [Google Scholar]
- Miller J. H., Jr, Googe J. M., Jr, Hoskins J. C. Combined macular hole and cataract surgery. Am J Ophthalmol. 1997 May;123(5):705–707. doi: 10.1016/s0002-9394(14)71092-x. [DOI] [PubMed] [Google Scholar]
- Minihan M., Goggin M., Cleary P. E. 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 Dec;81(12):1073–1079. doi: 10.1136/bjo.81.12.1073. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Park S. S., Marcus D. M., Duker J. S., Pesavento R. D., Topping T. M., Frederick A. R., Jr, D'Amico D. J. Posterior segment complications after vitrectomy for macular hole. Ophthalmology. 1995 May;102(5):775–781. doi: 10.1016/s0161-6420(95)30956-6. [DOI] [PubMed] [Google Scholar]
- Sheidow T. G., Gonder J. R. Cystoid macular edema following combined phacoemulsification and vitrectomy for macular hole. Retina. 1998;18(6):510–514. doi: 10.1097/00006982-199811000-00003. [DOI] [PubMed] [Google Scholar]
- Simcock P. R., Scalia S. Phaco-vitrectomy for full-thickness macular holes. Acta Ophthalmol Scand. 2000 Dec;78(6):684–686. doi: 10.1034/j.1600-0420.2000.078006684.x. [DOI] [PubMed] [Google Scholar]
- Tabandeh H., Chaudhry N. A., Smiddy W. E. Retinal detachment associated with macular hole surgery: characteristics, mechanism, and outcomes. Retina. 1999;19(4):281–286. doi: 10.1097/00006982-199907000-00002. [DOI] [PubMed] [Google Scholar]
- Thompson J. T., Glaser B. M., Sjaarda R. N., Murphy R. P. Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes. Am J Ophthalmol. 1995 Jan;119(1):48–54. doi: 10.1016/s0002-9394(14)73812-7. [DOI] [PubMed] [Google Scholar]
- Tornambe P. E., Poliner L. S., Grote K. Macular hole surgery without face-down positioning. A pilot study. Retina. 1997;17(3):179–185. doi: 10.1097/00006982-199705000-00001. [DOI] [PubMed] [Google Scholar]