Clinical outcomes of vitrectomy with air tamponade and 1-day prone positioning in the treatment of idiopathic macular hole / 中华眼底病杂志

ABSTRACT

Objective:To evaluate the surgical outcomes of 25G + vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH). Methods:A prospective analysis was performed on 39 patients (39 eyes) underwent 25G + pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G + PPV with 25% SF 6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF 6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t-test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test. Results:Thirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF 6 group. The distribution of age ( t=-1.63), gender ( χ 2=0.03), logMAR BCVA ( t=0.39), macular thickness ( t=-0.93), macular hole diameter ( t=-0.70), axial length ( t=-0.56), macular hole stages ( Z=-0.47) and pseudophakic status ( χ 2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF 6 group. There was no significant difference of closure rate between the two groups ( χ 2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes, 10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF 6 group. The proportion of visual acuity improvement in air group was lower than that in SF 6 group without the statistical significance ( Z=-0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF 6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF 6 group. All returned to normal limit after local medication. Conclusion:Compared to SF 6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.