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OCT based post-op positioning requirements in macular hole surgery

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 27/09/2013 | 11:00-12:30

Paper Time: 11:48

Venue: Hall 3 (Level 0)

First Author: D.Chow CANADA

Co Author(s):                  

Abstract Details

Purpose:

To evaluate a post-op positioning regimen after Macular hole surgery based on OCT evaluation of hole closure status.

Setting:

Prospective Consecutive Surgical series

Methods:

Following a standardized macular hole surgery (ILM removal with diluted ICG) patients were sent home with a complete gas fill of 20% SF6 gas in a prone position. On day 1 post-op an OCT was performed in a standard manner on the RT Vue (Optovue) to determine the status of hole closure. Prone positioning was stopped once closure of the hole could be documented on OCT. Patients were followed up daily until closure occurred.

Results:

30 patients underwent Macular hole surgery consecutively using this approach. In 28/30 the hole was confirmed closed on Day 1 postop at which point positioning was stopped. In 1 patient the hole was still open on Day 1 and positioning was continued until the hole closed on Day 4 post-op. In 1 patient, a Heme positioning sign on the corneal endothelium prevented adequate imaging which cleared by Day 2 with hole closure. During follow-up 3 holes reopened at 1 week follow-up; 2/3 were High Myopes, 1/3 large chronic hole, 1/3 was closed with repositioning, 1/3 was closed with a 2nd vitrectomy.

Conclusions:

An OCT based positioning regimen after macular hole surgery allowed 93% of patients to stop positioning with less than 1 day of positioning. However during follow-up 3 holes reopened at 1 week with 2/3 being HIgh Myopes and 1/3 Chronic hole. Repositioning after the hole reopened at 1 week was effective in 1 patient. For macular hole procedures in patients without High Myopia, Large holes or Chronic holes this OCT based positioning regimen was highly effective.

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