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.


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.


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).


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