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Macular hole surgery follow-up with spectral domain-optical coherence tomography-guided facedown posturing

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Abstract

Purpose

The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP.

Methods

Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded.

Results

Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260–max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed.

Conclusions

OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Yıldırım Beyazıt University Yenimahalle Education and Training Hospital, Ankara, 06900, Turkey

    Zeynep Eylul Ercan

  2. Department of Ophthalmology, Baskent University, Ankara, Turkey

    Sezin Akca Bayar, Imren Akkoyun & Gursel Yilmaz

  3. Department of Ophthalmology, Baskent University, Istanbul, Turkey

    Rengin Aslihan Kurt

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  1. Zeynep Eylul Ercan
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Contributions

Author contribution: RAK, SAB (Planning, Acquisition and preperation of data). ZEE (writing the main manuscript, figure preparation), IA (Acquisition of data, Preparation), GY (Acquisition of data, Supervision, review). The manuscript has been read and approved by all the authors.

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Correspondence to Zeynep Eylul Ercan.

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Ercan, Z.E., Akca Bayar, S., Kurt, R.A. et al. Macular hole surgery follow-up with spectral domain-optical coherence tomography-guided facedown posturing. Int Ophthalmol 44, 180 (2024). https://doi.org/10.1007/s10792-024-03110-z

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