Comparative study of the effects of room air and sulfur hexafluoride gas tamponade on functional and morphological recovery after macular hole surgery: a retrospective study

Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes - A randomized controlled trial (InFlap Study)

PURPOSE

To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH).

METHODS

A consecutive 99 eyes of 99 patients were enrolled {45 - conventional group and 54 - inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed.

RESULTS

At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group.

CONCLUSION

The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.

Vitrectomy with sulfur hexafluoride versus air tamponade for idiopathic macular hole: a retrospective study

BACKGROUND

To evaluate the effect of room air and sulfur hexafluoride (SF6) gas in idiopathic macular hole(MH)surgery.

METHODS

Retrospective, interventional, and comparative study. 238 eyes with the idiopathic macular hole that underwent pars plana vitrectomy, internal limiting membrane peeling, fluid-air exchange, and 20% SF6 (SF6 group:125 eyes) or room air tamponade (air group: 113 eyes) were reviewed. The primary outcome measure was the closure rate of primary surgery.

RESULTS

The baseline characteristics of the SF6 group and air group were comparable except for the hole size (479.90 ± 204.48 vs. 429.38 ± 174.63 μm, P = 0.043). The anatomical closure rate was 92.8% (116 / 125) with the SF6 group and 76.1% (86 / 113) with the air group (P < 0.001). A cut-off value of MH size to predict primary anatomical closure was 520 μm, which is based on the lower limit of 95% confidential interval of the MH size among the unclosed patients in the air group. There was no significant difference in anatomical closure rates between SF6 and air group (98.7% vs. 91.9%, P = 0.051) for MH ≤ 520 μm, whereas a significantly lower anatomical closure rate was shown in the air group than SF6 group (46.2% vs. 84.0%, P < 0.001) for MH > 520 μm.

CONCLUSION

SF6 exhibited more effectiveness than air to achieve a good anatomical outcome for its longer tamponade when MH > 520 μm.

COMPARISON OF AIR VERSUS PERFLUOROPROPANE INTRAOCULAR TAMPONADE COMBINED WITH VITRECTOMY FOR THE TREATMENT OF MACULAR HOLE IN HIGH MYOPIA

PURPOSE

To compare the efficacy of air and perfluoropropane (C3F8) with pars plana vitrectomy (PPV) in highly myopic macular holes (HMMHs) and explore the factors related to surgical prognosis.

METHODS

A retrospective comparison of a consecutive series of HMMHs undergone vitrectomy and internal limiting membrane peeling. According to tamponade type, they were divided into air group and C3F8 group, which were further divided into subgroups based on hole diameter or axial length (AXL). Anatomical and functional outcomes were compared between tamponades. Related factors of initial closure rate and postoperative best-corrected visual acuity (BCVA) were analyzed by logistic regression.

RESULTS

The baseline characteristics in air group (n = 63) and C3F8 group (n = 37) were similar except the age of air was older ( P = 0.019). The mean follow-up period was 17.16 ± 17.97 months. After surgery, the initial closure rate of air group was 85.7% and that of C3F8 group was 83.7% ( P = 0.780). And the initial closure rate showed no difference between tamponades in the same subgroup classified by hole diameter or AXL (all P > 0.05). Postoperative BCVA improved significantly in both groups ( P < 0.001), but no difference between them ( P = 0.793). Logistic regression showed that age, minimum linear diameter, and AXL were risk factors of initial closure rate, and preoperative BCVA was the only factor associated with postoperative BCVA (all P < 0.05).

CONCLUSION

With a long-term follow-up of HMMH, we found air had a similar tamponade effect anatomically and functionally compared with C3F8. Air may also be a good choice for patients with HMMH.

Intraocular Tamponade Choice with Vitrectomy and Internal Limiting Membrane Peeling for Idiopathic Macular Hole: A Systematic Review and Meta-analysis

TOPIC

A variety of different tamponade agents are used with vitrectomy combined with internal limiting membrane (ILM) peeling for the treatment of idiopathic macular holes. These agents include air, gas (sulfur hexafluoride [SF₆], hexafluoroethane [C₂F₆], and perfluoropropane [C₃F₈]), and silicone oil. The optimal tamponade agent is uncertain, and we aimed to review the effect of tamponade choice on hole closure and visual outcomes.

CLINICAL RELEVANCE

Although most surgeons initially chose to use long-acting gas (C₃F₈), there has been a gradual change in practice to the increasing use of the medium- (C₂F₆) and short-acting gases (SF₆) or even air. However, there is no consensus regarding their relative efficacies.

METHODS

Systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies comparing different tamponade agents in patients undergoing vitrectomy and ILM peeling for primary idiopathic macular holes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, whereas for nonrandomized studies, the Risk of Bias in Nonrandomized Studies of Interventions tool was used.

RESULTS

Thirteen publications, including 2 RCTs, were identified. Overall, there was no significant difference in the anatomic closure rates between studies using SF₆ compared with either C₃F₈ or C₂F₆ (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.51-1.08). A subgroup analysis showed a significantly higher closure rate using SF₆ (OR = 0.49; 95% CI = 0.30-0.79) in patients without postoperative posturing but not in those who were advised to posture facedown. The visual outcomes and adverse events were not significantly different. The comparisons of anatomic closure rates of patients treated with gas tamponade vs. silicone oil and with air vs. SF₆ showed no significant differences. The included studies had a number of methodological limitations and heterogeneities, making conclusions imprecise, with low or very low certainty by the Grades of Recommendation, Assessment, Development and Evaluation approach.

CONCLUSION

The current evidence base for tamponade selection with vitrectomy and ILM peeling for full-thickness macular hole has several major limitations. Further appropriately designed studies are needed to guide tamponade selection.

EFFICACY OF AIR TAMPONADE TREATMENT OF IDIOPATHIC MACULAR HOLES OF DIFFERENT DIAMETERS AND OF FOLLOW-UP INTRAVITREAL AIR TAMPONADE FOR PERSISTENT HOLES

PURPOSE

To evaluate the efficacy of air tamponade in idiopathic macular hole (iMH) surgery and of an additional intravitreal air injection in the treatment of persistent holes.

METHODS

Retrospective, observational case series. Sixty eyes of 60 patients with an iMH underwent phacoemulsification of cataract (when appropriate), pars plana vitrectomy, and internal limiting membrane peeling, followed by air tamponade. Eyes with persistent holes underwent an additional intravitreal air injection within 1 week after surgery. The iMH closure rate and the best-corrected visual acuity were evaluated.

RESULTS

In all 30 eyes with an iMH diameter <400 µm, the iMH closed after the primary surgery; however, only 17 of 30 eyes with an iMH diameter of ≥400 µm closed after the primary surgery. For the 13 eyes with persistent holes, an additional intravitreal air injection resulted in successful hole closure. There was no significant difference in the best-corrected visual acuity at the final follow-up between the closed subgroup and the initially unclosed subgroup after closure.

CONCLUSION

Pars plana vitrectomy combined with air tamponade effectively cured small iMHs. For large iMHs not closed after the primary surgery, an additional intravitreal air injection resulted in hole closure and achieved a good prognosis.

Air versus Sulfur Hexafluoride Gas Tamponade for Small and Medium Sized Macular Holes: a Randomized Noninferiority Trial

PURPOSE

To investigate whether air is noninferior to sulfur hexafluoride (SF₆) gas tamponade for small (≤250 μm) and medium sized (>250 μm and ≤400 μm) macular holes (MH).

DESIGN

Multicenter, randomized controlled, noninferiority trial.

PARTICIPANTS

Patients ≥18 years of age undergoing surgery for primary MH ≤400 μm in diameter.

METHODS

Both groups underwent conventional pars plana vitrectomy with peeling of the internal limiting membrane. At the end of the surgery, the patients were randomized to receive air or SF₆ gas tamponade stratified by MH size. Postoperatively, the patients followed a nonsupine positioning regimen for three days.

MAIN OUTCOME MEASURES

The primary endpoint was MH closure rate after a single surgery, confirmed by optical coherence tomography after 2-8 weeks. The noninferiority margin was set at a 10 percentage points difference in closure rate.

RESULTS

A total of 150 patients were included, 75 in each group. In the intention to treat (ITT) analysis, 65 out of 75 patients in the air group achieved primary closure. All 75 MH in the SF₆ group closed after a single surgery. Six patients were excluded from the per protocol (PP) analysis. In the PP analysis, 63 out of 70 patients in the air group and all 74 patients in the SF₆ group achieved MH closure after a single surgery, resulting in closure rates of 90% (95% confidence interval [CI], 79.9-95.5%) and 100% (95% CI, 93.9-100%), respectively. For the difference in closure rates, the lower bound of a two-sided 95% CI exceeded the noninferiority margin of 10% in both the ITT analysis and the PP analysis. In the subgroup of small MH, all 20 patients in the air group and all 28 patients in SF₆ group achieved primary closure.

CONCLUSIONS

This prospective randomized controlled trial proved that air tamponade is inferior to SF₆ tamponade for MH ≤400 μm in diameter.

Air-Liquid Exchange by Free Hand and One Needle for Unhealed Macular Hole

Aim

To report the treatment of 7 cases of unsealed hole after macular hole surgery with air-fluid exchange.

Methods

Retrospective case series. We collected 7 eyes of 7 patients with unsealed hole an unsealed hole about 2 weeks after macular hole surgery (23G vitrectomy with internal limiting membrane peeling with sterilizing air tamponade) in our hospital from February 2018 to December 2018. All patients underwent “air-liquid exchange by free hand and one needle.” The prone position was taken one week after operation. The macular holes before and after operation were examined by frequency-domain optical coherence tomography (SD-OCT).

Results

The size of the macular hole before vitrectomy was 481 ± 156 μm (range: 281–609 μm). Two weeks after vitrectomy (before air and liquid exchange), the size of the macular hole was 295 ± 92 μm (range: 210–421 μm). All macular holes were closed within 7–14 days after air-liquid exchange. There was no complaint of discomfort among these patients.

Conclusion

From this preliminary study, air-liquid exchange by free hand and one needle seems to be safe and effective in the treatment for patients with unsealed and tiny macular hole after vitrectomy as the lack of long effective gas in China. However, the exact efficacy and safety need further large case studies.

PUMCH experience and strategy for the management of idiopathic macular hole: a retrospective cohort study

PURPOSE

To introduce and evaluate a modified therapeutic strategy for idiopathic macular holes (IMH).

METHODS

A retrospective review of patients with diagnosis of IMH from July 2016 to January 2020 at Peking Union Medical College Hospital. These patients were managed strictly according to our therapeutic strategy. Their comprehensive clinical data were collected and analyzed.

RESULTS

209 eyes suffering stage II to IV IMH were identified. For stage II IMH, the spontaneous closure rate was 8.9%, the initial success rate of intravitreal injections (IVI) of expansile gas and pars plana vitrectomy (PPV) + internal limiting membrane peeling (ILMP) + air tamponade was 84.2% and 100%, respectively. The initial success rate of PPV + ILMP + air tamponade for stage III and stage IV IMH was 89.8% and 86.4%, respectively. Following our intervention strategy, stage II IMH achieved a final IMH closure rate of 100%, stage III of 99% and stage IV of 97%. The final best corrected visual acuity was significantly improved (P < 0.05). Sitting position air-fluid (A-F) exchange alone successfully induced IMH closure in 7/19 eyes that did not achieve IMH closure by initial PPV. For three refractory cases that failed additional PPV + ILM stuffing, intraoperative OCT assisted PPV + sub-retinal BSS injection successfully induced the IMH closure. As the remaining three unclosed IMH cases were dry and stable, no more interventions were conducted.

CONCLUSION

The general IMH closure rate based on our therapeutic strategy was satisfactory with a favorable prognosis. IVI expansile gas and sitting position A-F exchange were effective and highly cost-effective under certain circumstances.

Comparison between Fovea-Sparing and Complete Internal Limiting Membrane Peeling for the Treatment of Myopic Traction Maculopathy: A Systemic Review and Meta-Analysis

INTRODUCTION

Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial.

OBJECTIVES

The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP.

METHODS

Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution.

RESULTS

There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72-18.44; p = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] -0.09; 95% CI: -0.18 to 0.00; p = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00-0.27; p = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15-1.02; p = 0.05), postoperative central foveal thickness (MD -10.02; 95% CI: -24.4 to 4.36; p = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15-1.03; p = 0.06), and time to resolution (MD -1.65; 95% CI: -3.66 to 0.36; p = 0.11) showed no significant differences.

CONCLUSION

PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.

INTERNAL LIMITING MEMBRANE PEELING AND AIR TAMPONADE FOR STAGE III AND STAGE IV IDIOPATHIC MACULAR HOLE

PURPOSE

To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes.

METHODS

One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed.

RESULTS

The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months).

CONCLUSION

Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.

Surgical Treatment of Idiopathic Macular Hole Using Different Types of Tamponades and Different Postoperative Positioning Regimens

Purpose

To compare the effect of different types of intraocular tamponade and different types of postoperative positioning on the closure of idiopathic macular hole (IMH).

Methods

Prospective randomized clinical trial enrolling 104 eyes of 100 patients (age, 57–87 years) undergoing MH surgery. All patients were operated on by an experienced surgeon using 25-gauge pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Patients were randomized according to the type of intraocular tamponade and postoperative positioning into the following four groups: SF6 + nonsupine reading position (n = 26) (group 1), air + nonsupine reading position (n = 25) (group 2), air + prone position (n = 26) (group 3), or SF6 + prone position (n = 27) (group 4). The follow-up period was 6 months.

Results

MH closure was achieved in 87 eyes (83.7 %) in the overall sample after the first surgery, with closure rates of 100%, 56%, 84.6%, and 92.6% in groups 1, 2, 3, and 4, respectively. The group 2 was significantly less successful compared to the other three groups (p < 0.05). MH of sizes ≤400 µm was closed in 97.2% of cases after the first surgery, with no significant differences between groups (p = 0.219). MH with sizes over 400 µm was closed in 70.9% of cases after the first surgery, with both groups with air tamponade being significantly less successful than group 1. The nonsupine reading position was subjected to a better subjective evaluation in terms of postoperative comfort and quality of sleep, with no differences between air and SF6 tamponade tolerance.

Conclusion

PPV with ILM peeling, intraocular tamponade, and positioning remains the basic surgical approach in the treatment of IMH. For MH ≤ 400 µm, a high closure rate can be achieved by combining air tamponade and nonsupine reading position. For macular holes >400 µm, the greatest anatomical success can be achieved by using the SF6 tamponade in combination with the nonsupine reading position.

Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes

BACKGROUND

To determine whether preoperative hole diameter ratio (HDR) is a predictive factor for postoperative anatomical outcome for stage III or IV idiopathic macular holes (IMHs).

METHODS

One-hundred and one eyes with stage III or IV IMH were included in this retrospective case series study. All cases were treated with vitrectomy combined with internal limiting membrane (ILM) peeling and room air tamponade. The macular hole (MH) minimum and maximum diameter was measured on preoperative optical coherence tomography (OCT) images. The HDR was defined as the minimum to maximum diameter ratio.

RESULTS

Eighty-one eyes (80.2%) got a Type I closure after surgery (group A). Postoperative unclosed MHs were found in 20 eyes (19.8%) (group B). The preoperative minimal diameter (703.6 ± 116.1 μm vs. 597.6 ± 120.1 μm, P < 0.01) and HDR (0.6 ± 0.1 vs. 0.5 ± 0.1, P = 0.01) were both significantly smaller in postoperative closed eyes. The closure rate of IMHs with HDR < 0.6 was significantly higher than those with HDR ≥ 0.6 (90.2% vs. 65.0%P = 0.002) .

CONCLUSIONS

Preoperative HDR < 0.6 is predictive for a good postoperative anatomical outcome in stage III or IV IMHs.

Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials

Purpose

To compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique with the conventional ILM peeling for idiopathic large macular holes (MHs).

Methods

A meta-analysis of randomized control trials (RCTs) using online databases including NCBI PubMed, ClinicalTrials.gov, and ISI Web of Science was performed. Anatomic success and type 1 closure rates, the mean postoperative best-corrected visual acuity (BCVA) and the mean change of BCVA from baseline were analyzed.

Results

Out of 251 articles, four described clinical trials matching the inclusion criteria and were selected. They included 276 eyes (135 eyes in the inverted ILM flap group and 141 eyes in the ILM peeling group). All the studies used gas tamponade, with two studies having a follow-up duration of 3 months, while one study had a follow-up of 6 months and one study– 12 months. The meta-analysis demonstrated that anatomic success and type 1 closure rates (presence of neurosensory retina in MH) were better in the inverted ILM flap technique (odds ratio (OR) = 4.89; 95% confidence interval (CI), 2.09–11.47; P = 0.0003 and OR = 5.23; 95% CI, 2.83–9.66; P<0.00001). Similarly, the inverted flap technique was superior in terms of postoperative logMAR BCVA and mean change of logMAR BCVA from baseline (weighted mean difference (WMD) = 0.17, 95% CI, 0.11 to 0.24, P<0.00001 and WMD = 0.08, 95% CI, 0.01 to 0.16, P = 0.03)

Conclusion

Inverted ILM flap treatment resulted in better closure rates and visual acuity when compared to the standard ILM peeling for large MHs.

The macular microstructure repair and predictive factors of surgical outcomes after vitrectomy for idiopathic macular hole

To evaluate the macular microstructure repair and explore the factors related to those changes and visual improvement after vitrectomy for idiopathic macular hole (IMH). Totally 19 eyes of 18 IMH patients who underwent macular hole (MH) surgery were evaluated with best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) images. All 19 eyes closed at 6mo postoperatively. BCVA was observed gradually improved (P<0.001), with subretinal fluid (SRF) gradually absorbed (P=0.021) and the rate of external limiting membrane (ELM) defects gradually decreased (P=0.011) with follow-up time. Poorer postoperative logMAR BCVA correlated with larger MH minimum diameter (P<0.001), larger MH basal diameter (P=0.008), longer symptom duration (P=0.002) and poorer preoperative logMAR BCVA (P=0.010). More improvement in BCVA correlated only with poorer preoperative in logMAR BCVA (P=0.002). The earlier reconstruction of ELM was associated with smaller MH basal diameter (P=0.022) and shorter symptom duration (P=0.008). In conclusion, smaller basal diameter of MH and shorter symptom duration were key factors in earlier reconstruction of ELM.

A Comparative Study of Vitrectomy Combined with Internal Limiting Membrane Peeling for the Treatment of Idiopathic Macular Hole with Air or C3F8 Intraocular Tamponade

Purpose

The treatment of idiopathic macular holes has been basically modeled, and vitreoretinal surgery is recognized as an effective treatment. However, the postoperative tamponade of gas will still make the patient uncomfortable and may have related complications. The purpose of this study is to investigate whether air as an intraocular tamponade is equivalent to gas and what advantages may exist.

Methods

A retrospective study was performed in one hundred and ninety-eight patients from 2013 to 2017; 112 received gas tamponade and 86 received air tamponade. After receiving retinal surgery, the outcomes of best corrected visual acuity, intraocular pressure, slit lamp examination, fundus examination, and imaging of the macula by spectral-domain optical coherence tomography were analyzed.

Results

Before operation, there was no statistically significant difference in age, sex, macular hole diameter, or visual acuity between groups. The median follow-up period for the C3F8 group was 26 months, and the median follow-up for the air group was 25 months. After the operation, the best corrected visual acuity and macular hole closure rate were not significantly different between the two groups. The face-down time after the operation, the incidence of lens opacity on the third postoperative day, the intraocular pressure on the third postoperative day, and the operation time were significantly different between the two groups.

Conclusions

In idiopathic macular hole surgery, the effect of air as an intraocular tamponade material can be similar to that of C3F8 but has fewer complications. In particular, it is a better choice for patients for whom the face-down position is not suitable.

A Review of Surgical Outcomes and Advances for Macular Holes

The surgical outcomes of macular holes (MHs) have improved greatly in recent years. The closure rate is as high as 90-100%, but the outcomes of some special types of MHs remain unsatisfactory. Internal limiting membrane (ILM) peeling dramatically improves the anatomic success rate, but recent studies have found that it could also cause mechanical and subclinical traumatic changes to the retina. Dyes are widely used, and apart from indocyanine green (ICG), the toxicities of other dyes require further research. Face-down posturing is necessary for MHs larger than 400 μm, and the duration of this posture is determined by the type of tamponade and the case. The ellipsoid zone has been shown to be highly correlated with visual outcome and recovery. New surgical methods include the inverted ILM flap technique and the ILM abrasion technique. However, they require further research to determine their effectiveness.

SULFURHEXAFLUORIDE (SF6) VERSUS PERFLUOROPROPANE (C3F8) GAS AS TAMPONADE IN MACULAR HOLE SURGERY

PURPOSE

To compare outcomes of macular hole surgery using sulfurhexafluoride (SF6) versus perfluoropropane (C3F8) gas.

METHODS

This is a retrospective, interventional, comparative study. A total of 177 eyes of 166 patients operated over a 3-year period for idiopathic macular holes were included. Sixty-seven eyes had tamponade with SF6 gas (Group 1), whereas 111 eyes received C3F8 (Group 2) as the tamponading agent. The primary outcome measure was the macular hole closure rate. Statistical analysis was done using SPSSv16.

RESULTS

Spectral domain optical coherence tomography-based stagewise distribution of macular holes were similar across both groups (P = 0.99). The hole closure rate was 57/66 (86.4%) with SF6 and 96/111 (86.5%) with C3F8 gas (P = 0.98). Subanalysis demonstrated no significant difference in closure rates regarding macular hole size, stage, or duration. Best-corrected visual acuity improved by a mean of 0.28 logMAR in the SF6 group (P = 0.00) and 0.42 logMAR in the C3F8 group, corresponding to 3 lines and 4 lines of improvement, respectively, on the Early Treatment Diabetic Retinopathy Study chart (P < 0.05). The difference was not significant (P = 0.06). Rise in intraocular pressure was higher in the C3F8 group (P < 0.05). Progression of cataract was also greater in the C3F8 group (83.3 vs.73.9%), but it was not statistically significant (P = 0.20). Resurgery was done in 9/177 eyes. The closure rate with C3F8 and SF6 reinjections was 3/4 (75%) and 1/5 (20%). Moreover, anatomical hole closure after resurgeries was better in Group 1 (4/5 eyes) than in Group 2 (0/4 eyes).

CONCLUSION

The macular hole closure rate was similar with sulfurhexafluoride and perfluoropropane, irrespective of hole size, stage, or duration. However, sulfurhexafluoride exhibited a decreased incidence of cataract and ocular hypertension with shorter tamponade duration. Perfluoropropane may have a role as the preferred endotamponading agent in failed primary surgeries.

Recovery of photoreceptor layer on spectral-domain optical coherence tomography after vitreous surgery combined with air tamponade in chronic idiopathic macular hole

BACKGROUND AND OBJECTIVE

Studies using sterilized air in chronic idiopathic macular holes show varying success rates, and the impact of a shorter duration of tamponade on photoreceptor layer recovery is not fully elucidated.

PATIENTS AND METHODS

Surgical outcomes of 35 cases (seven in stage 3 and 28 in stage 4) were assessed for best corrected visual acuity and with spectral-domain optical coherence tomography.

RESULTS

The primary closure rate was 91.4%, and the closed cases and unclosed cases were significantly different in the preoperative (P = .042) and postoperative (P = .040) diameter of the photoreceptor layer defect. After surgery, there was a significant improvement in best corrected visual acuity and a decrease in the photoreceptor layer defect. The postoperative logarithm of the minimal angle of resolution was significantly correlated with the preoperative hole diameter (P = .003) and the postoperative diameter of the photoreceptor layer defect (P = .005).

CONCLUSION

Air tamponade is a safe and effective treatment for chronic and severe macular holes, with several spectral-domain optical coherence tomography parameters highly predictive of postoperative visual acuity.