John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

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Face Down Recovery After Macular Hole Surgery May Be Unnecessary

Oct 09, 2013 - 2 comments

Macular Hole Surgery



From one of the most prestigious medical journals:

OPHTHALMOLOGY   V120 #10 Pages 1998-2003 October 2013


To demonstrate the efficacy of broad internal limiting membrane (ILM) peeling and 20% sulfur hexafluoride (SF6) endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes (MHs).


Retrospective study.


Sixty-eight idiopathic MH cases in 68 eyes of 65 patients.


All idiopathic MH surgeries by 1 surgeon between March 2009 and December 2012, performed using broad ILM peeling, 20% SF6, and no face-down positioning, were reviewed. No cases were excluded. Surgeon method included 23-gauge or 25-gauge pars plana vitrectomy with induction of posterior vitreous detachment (if necessary). Indocyanine green dye (0.08 mg/ml in D5W) was injected slowly, allowed to stain for 60 seconds, and then removed. The ILM was broadly peeled to the vascular arcades (approximately 8000 μm in diameter), followed by 2 fluid–air exchanges, separated by 5 minutes, and an air–20% SF6 exchange. Patients maintained reading position for 3 to 5 days and were followed up at least for 1 month. Exact binomial distributions were used to establish 95% confidence intervals, and the 1-way analysis of variance was used to compare preoperative and postoperative intraocular pressures (IOPs).

Main Outcome Measures

Single-procedure MH closure rate, mean postoperative best-corrected visual acuity (BCVA), incidence of cataract, and IOP.


Three patients (4.6%) had bilateral MH and 9 patients (13.8%) had recurrent MH (mean duration from previous surgery, 8.3±5.5 years; range, 1–16 years). Twenty-one MH (30.9%) were stage 2, 27 (39.7%) were stage 3, and 20 (29.4%) were stage 4. Five MH had a basal diameter of more than 1000 μm. Mean MH basal diameter was 609.6±226.2 μm. Mean preoperative BCVA was 0.68±0.29 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/95), and mean most recent postoperative BCVA was 0.28±0.18 logMAR units (Snellen equivalent, 20/38). The single-procedure MH closure rate was 100% (95% confidence interval, 95%–100%), and no complications were observed.


Macular hole surgery with broad ILM peeling, 20% SF6 gas, and no face-down positioning is highly effective in the surgical treatment of idiopathic MH with efficacy comparable with methods that use longer-acting gas endotamponade, face-down positioning, or both. In our series, this method eliminated the morbidity associated with postoperative face-down positioning.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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by carmdr, Feb 11, 2015
Doctor, may I know if this is through vitrectomy?  

What I would like to really know is the success of vitrectomy operation for Macular Hole? If the patient has a distorted vision before the repair, will after vitrectomy the patient cannot anymore have distorted vision?


Yes the surgery is done by vitrectomy technique.  No standards exist like cataract surgery. Vision after surgery depends on the size and depth of the macular hold, most patients have improved vision, most patients do have some distortion (metamorphopsia)  after surgery though less than before.

A very small hole that is not full thickness might have 20/20 while a full thickness, large hole may only see 20/400


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