Purpose:

To assess the anatomical and functional outcomes of macular hole surgery with pars plana vitrectomy (PPV), internal limiting membrane peeling and gas tamponade (SF6, C2F6, or C3F8) with a non-strict postoperative posturing regimen.

Setting: Gloucestershire Hospitals NHS Trust, United Kingdom.

Methods:

Clinical and surgical data were prospectively entered into an electronic medical record (Medisoft, Leeds, UK). Data of consecutive macular hole surgeries operated between 2005 and 2012 using 20 G PPV from 3 consultant-lead teams were included in this study. A regimen of prone posturing for the first night and then no posturing except to avoid sleeping supine for 1 week was adopted by all surgeons. Selection of the gas tamponade was mainly based on surgeon’s discretion. Data collection included: demographic details, stage of macular hole, tamponade type, phakic status, preoperative and postoperative visual acuity (VA), anatomical success rate, secondary cataract surgery rate and intraoperative and post-operative complication rates.

Results:

301 eyes of 278 patients with a mean age of 69.3 ±8.23 years (mean ±SD)(median: 69) and a 1:2.5 male to female ratio were included. Macular holes were stage 2 in 28.7% of eyes, stage 3 in 57.5% and stage 4 in 14.7%. Preoperative mean VA was 0.88 ±0.32 LogMAR, and postoperative VA was 0.77 ±0.27 at 1st, 0.65 ±0.29 at 3rd, 0.60 ±0.30 at 6th, 0.47 ±0.27 at 12th and 0.46 ±0.28 at 24th month. Complete closure with flattening against the retinal pigment epithelium was achieved in 73.3% of eyes at 1st, 88.7% at 3rd, 90.3% at 6rd and 91.6% at 12th months, with an overall final closure rate of 92.9% (97.1% for stage 2, 91.3% for stage 3 and 85.3% for stage 4, p:0.06). Primary PPV success rate was 92% (230/251) with a failure rate of 8% (4.4% for stage 2, 9.4% for stage 3 and 11.8% for stage 4, p:0.16). 52% (11/21) of patients with primary failure declined further interventions. Secondary PPV success rate was 40% (4/10) and 1 patient required a 3rd intervention. Intraoperative complications rate (25.2%, most commonly iatrogenic retinal tears) were associated with surgeon experience (consultants 18.5% vs fellows 33.8%, p:0.002) and lens status (phakic 28.9% vs pseudophakic 14.6%, p:0.050). Post-operative retinal detachment occurred in 0.8% (2/251 eyes).

Conclusions:

Macular hole surgery with non-strict postoperative posturing provides good anatomical and functional outcomes. Operative complications were common but rarely visually significant.