The hole closure rate of swept-source optical coherence tomography-guided facedown positioning for macular hole surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Zeng Miao , Cai Chunyan , Chen Xiao ,  Hong Ling , Ding Qin , Yan Ying , Huang Zhijian

Wuhan General Hospital of Chinese People’s Liberation Army, Wuhan 430070, China (Cai Chunyan, Wuhan Aier Eye Hospital);

Corresponding author：

Hong Ling, Email: zengmiao1982@163.com

Keywords：

Tomography, optical coherence; Vitreoretinal surgery; Retinal perforations/surgery

DOI：

10.3760/cma.j.issn.1005-1015.2018.02.008

Video：

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Objective To observe the hole closure rate of swept-source optical coherence tomography (SS-OCT)-guided facedown positioning for idiopathic macular hole (IMH) surgery. Methods A retrospective case series of 64 eyes of 64 patients affected with IMH. All the patients underwent a 25G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intraocular perfluoropropane (C₃F₈) tamponade. In 35 eyes of 35 patients, the facedown positioning was halted after detecting an hole closure through intraocular gas in the SS-OCT images at the early period after surgery (the SS-OCT group). In 29 eyes of 29 patients, the facedown positioning was halted atter detecting an hole closure in the SS-OCT images when the macular zone was uncovered by intraocular gas (the control group). The follow-up was ranged from 6 to 11 months, with the mean follow-up time was 8.4 months. The hole closure rate at 6 months after surgery were compared between two groups by two independent sample Wilcoxon rank sum test. The duration of the facedown positioning and complications were compared between two groups. Results The period of facedown position was (1.67±1.28) and (7.65±1.42) days in the SS-OCT group and control group, respectively. The difference of the period of facedown position between the two groups was significant (Z=−6.784, P＜0.05). At 6 months after surgery, the hole closure was detected in 30 eyes (85.71%) in the SS-OCT group and in 27 eyes (93.10%) in the control group. There was no difference of hole closure rate between the two groups (χ²=0.889, P＞0.05). There was no ocular serious side effect during the follow up, such as leakage of sclera incision, retinal hemorrhage, choroidal hemorrhage and endophthalmitis. In the control group, there were two patients with mild dizziness who underwent symptomatic treatment. There was no systemic side effect during the follow-up in the SS-OCT group. Conclusion Confirming with SS-OCT imaging early closure of macular hole of IMH patients with gas tamponade can serve as an important guide to significantly shorten the period of facedown positioning, while achieved a high hole closure rate.

Citation： Zeng Miao, Cai Chunyan, Chen Xiao, Hong Ling, Ding Qin, Yan Ying, Huang Zhijian. The hole closure rate of swept-source optical coherence tomography-guided facedown positioning for macular hole surgery. Chinese Journal of Ocular Fundus Diseases, 2018, 34(2): 139-143. doi: 10.3760/cma.j.issn.1005-1015.2018.02.008 Copy

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2.	Lois N, Burr J, Norrie J, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial[J]. Invest Ophthalmol Vis Sci, 2011, 52(3): 1586-1592. DOI: org/10.1167/iovs.10-6287.
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5.	Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5): 629-639. DOI: org/10.1001/archopht.1988.01060130683026.
6.	Lezzi R, Kapoor KG. No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes[J]. Ophthalmology, 2013, 120(10): 1998-2003. DOI: org/10.1016/j.ophtha.2013.06.001.
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10.	Lange CA, Membrey L, Ahmad N, et al. Pilot randomized controlled trial of face-down positioning following macular hole surgery[J]. Eye (Lond), 2011, 26(2): 272-277. DOI: org/10.1038/eye.2011.221.
11.	Kumagai K, Furukawa M, Ogino N, et al. Incidence and factors related to macular hole reopening[J]. Am J Ophthalmol, 2010, 149(1): 127-132. DOI: org/10.1016/j.ajo.2009.08.002.
12.	Yorston D, Siddiqui MA, Awan MA, et al. Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole[J]. Eye, 2011, 26(2): 267-271. DOI: org/10.1038/eye.2011.220.
13.	Tadayoni R, Vicaut E, Devin F, et al. A randomized controlled trial of alleviated positioning after small macular hole surgery[J]. Ophthalmology, 2011, 118(1): 150-155. DOI: org/10.1016/j.ophtha.2010.04.040.
14.	Tranos PG, Peter NM, Nath R, et al. Macular hole surgery without prone positioning[J]. Eye (Lond), 2006, 21(6): 802-806. DOI: org/10.1038/sj.eye.6702339.
15.	Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after diopathic macular hole surgery: a randomized clinical trial[J]. Am J Ophthalmol, 2008, 146(1): 128-134. DOI: org/10.1016/j.ajo.2008.02.029.
16.	Ohno-Matsui K, Akiba M, Moriyama M, et al. Imaging retrobulbar subarachnoid space around optic nerve by swept-source optical coherence tomography in eyes with pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2011, 52(13): 9644-9650. DOI: org/10.1167/iovs.11-8597.
17.	Kikushima W, Imai A, Toriyama Y, et al. Dynamics of macular hole closure in gas-filled eyes within 24 h of surgery observed with swept source optical coherence tomography[J]. Ophthalmic Res, 2015, 53(1): 48-54. DOI: org/10.1159/000368437.
18.	Shah SP, Manjunath V, Rogers AH, et al. Optical coherence tomography-guided facedown positioning for macular hole surgery[J]. Retina, 2013, 33(2): 356-362. DOI: org/10.1097/iae.0b013e318263d0e8.
19.	Chow DR, Chaudhary KM. Optical coherence tomography-based positioning regimen for macular hole surgery[J]. Retina, 2015, 35(5): 899-907. DOI: org/10.1097/iae.0000000000000410.

1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study[J]. Arch Ophthalmol, 1991, 109(5): 654-659. DOI: org/10.1001/archopht.1991.01080050068031.
2. Lois N, Burr J, Norrie J, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial[J]. Invest Ophthalmol Vis Sci, 2011, 52(3): 1586-1592. DOI: org/10.1167/iovs.10-6287.
3. Forsaa VA, Raeder S, Hashemi LT, et al. Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery[J]. Acta Ophthalmologica, 2012, 91(6): 547-551. DOI: org/10.1111/j.1755-3768.2012.02464.x.
4. Krohn J. Duration of face-down positioning after macular hole surgery: a comparison between 1 week and 3 days[J]. Acta Ophthalmol Scand, 2005, 83(3): 289-292. DOI: org/10.1111/j.1600-0420.2005.00462.x.
5. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5): 629-639. DOI: org/10.1001/archopht.1988.01060130683026.
6. Lezzi R, Kapoor KG. No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes[J]. Ophthalmology, 2013, 120(10): 1998-2003. DOI: org/10.1016/j.ophtha.2013.06.001.
7. Gupta D. Face-down posturing after macular hole surgery: a review[J]. Retina, 2009, 29(4): 430-443. DOI: org/10.1097/iae.0b013e3181a0bd01.
8. Isomae T, Sato Y, ShimaIsomae T, et al. Shortening the duration of prone positioning after macular hole surgery-comparison between 1-week and 1-day prone positioning[J]. Jpn J Ophthalmol, 2002, 46(1): 84-88. DOI.org/10.1016/s0021-5155(01)00468-3.
9. Tatham A, Banerjee S. Face-down posturing after macular hole surgery: a meta-analysis[J]. Br J Ophthalmol, 2010, 94(5): 626-631. DOI: org/10.1136/bjo.2009.163741.
10. Lange CA, Membrey L, Ahmad N, et al. Pilot randomized controlled trial of face-down positioning following macular hole surgery[J]. Eye (Lond), 2011, 26(2): 272-277. DOI: org/10.1038/eye.2011.221.
11. Kumagai K, Furukawa M, Ogino N, et al. Incidence and factors related to macular hole reopening[J]. Am J Ophthalmol, 2010, 149(1): 127-132. DOI: org/10.1016/j.ajo.2009.08.002.
12. Yorston D, Siddiqui MA, Awan MA, et al. Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole[J]. Eye, 2011, 26(2): 267-271. DOI: org/10.1038/eye.2011.220.
13. Tadayoni R, Vicaut E, Devin F, et al. A randomized controlled trial of alleviated positioning after small macular hole surgery[J]. Ophthalmology, 2011, 118(1): 150-155. DOI: org/10.1016/j.ophtha.2010.04.040.
14. Tranos PG, Peter NM, Nath R, et al. Macular hole surgery without prone positioning[J]. Eye (Lond), 2006, 21(6): 802-806. DOI: org/10.1038/sj.eye.6702339.
15. Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after diopathic macular hole surgery: a randomized clinical trial[J]. Am J Ophthalmol, 2008, 146(1): 128-134. DOI: org/10.1016/j.ajo.2008.02.029.
16. Ohno-Matsui K, Akiba M, Moriyama M, et al. Imaging retrobulbar subarachnoid space around optic nerve by swept-source optical coherence tomography in eyes with pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2011, 52(13): 9644-9650. DOI: org/10.1167/iovs.11-8597.
17. Kikushima W, Imai A, Toriyama Y, et al. Dynamics of macular hole closure in gas-filled eyes within 24 h of surgery observed with swept source optical coherence tomography[J]. Ophthalmic Res, 2015, 53(1): 48-54. DOI: org/10.1159/000368437.
18. Shah SP, Manjunath V, Rogers AH, et al. Optical coherence tomography-guided facedown positioning for macular hole surgery[J]. Retina, 2013, 33(2): 356-362. DOI: org/10.1097/iae.0b013e318263d0e8.
19. Chow DR, Chaudhary KM. Optical coherence tomography-based positioning regimen for macular hole surgery[J]. Retina, 2015, 35(5): 899-907. DOI: org/10.1097/iae.0000000000000410.

Chinese Journal of Ocular Fundus Diseases

The hole closure rate of swept-source optical coherence tomography-guided facedown positioning for macular hole surgery

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