Surgical Outcomes of Taking a Reading Position after Air Tamponade in Idiopathic Macular Hole

Young Ki Kwon; Sun Jung Eum; Jae Pil Shin; In Taek Kim; Dong Ho Park

doi:10.3341/jkos.2015.56.11.1752

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Kwon, Eum, Shin, Kim, and Park: Surgical Outcomes of Taking a Reading Position after Air Tamponade in Idiopathic Macular Hole

Original Article

J Korean Ophthalmol Soc 2015;56(11):1752-1758.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1752

Surgical Outcomes of Taking a Reading Position after Air Tamponade in Idiopathic Macular Hole

Young Ki Kwon, M.D, Sun Jung Eum, M.D, Jae Pil Shin, M.D, PhD, In Taek Kim, M.D, PhD, Dong Ho Park, M.D, PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Dong Ho Park, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Samdeok-dong 2(i)-ga, Jung-gu, Daegu 41944, Korea Tel: 82-53-420-5813, Fax: 82-53-426-6552 E-mail: sarasate2222@gmail.com

‗ This study was presented as an e-poster at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

‗ This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A1A2055007) and by the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A111345).

Received 24 April 201524 June 2015 Accepted 21 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

In this study we compared the postoperative hole closure rate and average vision between a group who assumed a face-down position for a week using gas and a group who assumed a reading position after fluid air exchage (FAX), both after re-ceiving internal limiting membrane (ILM) peeling during vitrectomy in patients with idiopathic macular hole.

Methods

This study included 25 eyes of patients diagnosed with idiopathic macular hole that underwent vitrectomy. Group I as-sumed a face-down position for a week after intraocular gas tamponade after FAX during vitrectomy and Group II assumed a reading position for 3 days after only FAX. The hole closure rate and the best-corrected visual acuity (BCVA) were compared be-tween the 2 groups 6 months postoperatively.

Results

The preoperative mean macular hole size was 456.2 ± 164.1 µm in Group I and 411.2 ± 105.7 µm in Group II and the differences between the 2 groups were not statistically significant ( p = 0.647). At 6 months after surgery, the macular hole clo-sure rate was 93% in Group I and 100% in Group II ( p = 0.571) and the BCVA (log MAR) was 0.82 ± 0.29 preoperatively and 0.92 ± 0.35 postoperatively in Group I and 0.71 ± 0.39 and 0.97 ± 0.33 in Group II, respectively. The differences between the 2 groups ( p = 0.09, p = 0.058) were not statistically significant ( p = 0.809, p = 0.267).

Conclusions

There was no significant differences in the macular hole closure rate and BCVA improvement after 6 months in pa-tients with idiopathic macular hole who had FAX during vitrectomy and maintained only a reading position for 3 days compared with those with gas tamponade and who maintained a face-down position for a week. This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.

Keywords: Air tamponade, Macular hole, No prone position, Reading position

References

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Figure 1.

Spectral-domain optical coherence tomography (SD-OCT) images after macular hole surgery obtained from case 18. (A) Initial examination. SD-OCT demonstrated full thickness macular hole in left eye, minimum macular hole diameter is 326 μ m and basal diameter is 772 μ m. Preoperative stage showing stage 2 macular hole. Several intraretinal cysts are found in the perifoveal retina. (B) 1 day af-ter surgery, SD-OCT obtained through the air bubble shows resolution of the foveal cysts and macular hole was anatomically closed in left eye by the tissue including the ELM across the macular hole. (C) 2 days after surgery, Inner segment/outer segment (IS/OS) junction defect are present (arrow). (D) 7 days after surgery, macular hole is closed with foveal depression and IS/OS junction defect are still present apparently (arrowhead). Foveal lesion is more depressed than postoperative day 1. ELM = ex-ternal limiting membrane; Postop = postoperative.

Table 1.

Patient characteristics

Case No.	Age (years)	Sex	Size of minimum MH (μ m)	Size of base MH (μ m)	MH stage	Initial vision (log MAR)	Final vision (log MAR)	Follow up (months)	MH Closure	Tamponade
1	68	F	612	840	3	0.4	0.7	35	Closed	C₃ F₈
2	67	F	540	850	3	0.7	0.5	32	Closed	C₃ F₈
3	64	F	413	657	3	1.0	1.0	30	Closed	C₃ F₈
4	70	F	351	887	2	1.0	0.7	29	Closed	C₃ F₈
5	66	F	413	1,061	3	0.7	0.7	28	Closed	C₃ F₈
6	79	F	493	1,099	3	1.1	1.0	26	Unclosed	C₃ F₈
7	53	M	313	906	2	0.5	0.5	24	Closed	C₃ F₈
8	76	M	337	783	2	0.9	0.9	23	Closed	C₃ F₈
9	50	F	380	480	2	0.4	0.4	19	Closed	C₃ F₈
10	66	M	202	516	2	1.0	0.9	17	Closed	C₃ F₈
11	61	M	277	411	2	1.0	0.5	17	Closed	C₃ F₈
12	69	F	674	1,046	3	1.3	1.3	13	Closed	C₃ F₈
13	63	F	629	749	3	1.6	1.3	12	Closed	C₃ F₈
14	68	F	753	673	3	1.3	1.1	11	Closed	C₃ F₈
15	72	M	498	615	3	1.6	1.3	18	Closed	Air
16	71	M	302	731	2	1.0	0.7	16	Closed	Air
17	74	F	420	540	3	0.3	0.2	11	Closed	Air
18	62	F	326	772	2	1.0	0.5	10	Closed	Air
19	65	F	660	1,060	3	1.0	0.6	8	Closed	Air
20	64	F	317	587	2	1.3	0.6	7	Closed	Air
21	65	M	330	698	2	1.0	1.6	7	Closed	Air
22	54	F	350	450	2	0.6	0.4	7	Closed	Air
23	79	F	430	500	3	1.0	0.5	6	Closed	Air
24	75	M	420	480	3	0.9	0.6	6	Closed	Air
25	66	M	470	730	3	1.0	0.5	6	Closed	Air

MH = macular hole.

Table 2.

Preoperative ocular data

Group 1 (n = 14)	Group 2 (n = 11)	p-value^*
Sex (male/female)	4/10	5/6	0.764
Age (years)	65.7 ± 7.3	67.3 ± 7.4	0.609
Mean hole diameter (minimum size, μ m)	456.2 ± 164.1	411.2 ± 105.7	0.647
Mean hole diameter (base size, μ m)	782.7 ± 216.1	651.2 ± 175.2	0.095
Preoperative BCVA (log MAR)	0.92 ± 0.35	0.97 ± 0.33	0.809
Macular hole stage			0.936
Stage 2	6	5
Stage 3	8	6

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrected visual acuity.

^* Mann-Whitney test.

Table 3.

Outcomes of macular hole surgery

	Group 1 (n = 14)	Group 2 (n = 11)	p-value^*
Follow up period (months)	22.6 ± 7.8	10.7 ± 4.7	0.001
Postoperative mean BVCA (6 months, log MAR)	0.82 ± 0.29	0.71 ± 0.39	0.267
Primary closure rate (%)	93% (13/14)	100% (11/11)	0.571
Final closure rate (%)	93% (13/14)	100% (11/11)	0.571

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best-corrected visual acuity.

^* Mann-Whitney test.

Table 4.

Comparision of mean BCVA at preoperative time and at postoperative 6 months

	Preoperative BCVA (log MAR)	Postoperative BCVA (6 months, log MAR)	p-value^*
Group 1	0.92 ± 0.35	0.82 ± 0.29	0.090
Group 2	0.97 ± 0.33	0.71 ± 0.39	0.058

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

^* Wilcoxon signed rank test.

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