First Author: M.Veith CZECH REPUBLIC
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To compare outcomes of macular hole surgery using 25-gauge pars plana vitrectomy (PPV) with different types of tamponade and different types of postoperative positioning
Prospective study. 57 eyes of 57 patients (42 women, 15 men) of mean age 68.8 years (58-83) with the diagnosis of stage 2, 3, or 4 macular holes were included. The patients were randomized to three arms with different type of tamponade and postoperative positioning: 1) 20 % SF6 + prone position 3 days (n=23), 2) 20% SF6 + reading position 3 days (n=19), 3) Air + reading position 3 days (n=15). All patient undergone 25-gauge PPV with brilliant blue assisted broad internal limiting membrane (ILM) peeling in retrobulbar anesthesia. Optical coherence tomography findings, best corrected visual acuity (BCVA) and complications were evaluated.
The mean follow-up time was 4 months (1-12). Macular hole closure rate of primary surgery was 95.7 % in arm 1, 100 % in arm 2 and 73.3 % in arm 3. The mean BCVA improved from 0.15 to 0.40 in arm 1, from 0.13 to 0.49 in arm 2 and from 0.08 to 0.38 in arm 3. The mean intraocular pressure first postoperative day was 19.4 mmHg in arm 1 and 2, in arm 3 11.6 mmHg.
25-gauge PPV with ILM peeling and tamponade is safe and effective treatement method for macular hole. Reading positioning with SF6 tamponade is not inferior against prone positioning with SF6. Reading position with air tamponade is insufficient.