SILICONE OIL TAMPONADE TO SEAL MACULAR HOLES WITHOUT POSITION RESTRICTIONS

Objective: The authors performed a study to determine the effectivenes s and safety of silicone oil as a substitute for gas to fill the vitre ous cavity to treat macular holes. Design: Multicenter, nonrandomized, interventional trial. Participants: Thirty-seven consecutive patients chose vitrectomy with silicone tamponade instead of gas to treat 40 e yes with stage-2 to stage-4 idiopathic age-related macular holes. Stag e-2 holes constituted 40% of the holes, and stage-3 and stage-4 holes made up 60%. Intervention: All eyes were treated with vitrectomy, manu al detachment of the posterior vitreous face (not done for stage-4 hol es), autologous serum instillation, and silicone fill of the vitreous cavity. After insertion of the oil, the patients resumed normal activi ty with no restriction of head or eye position except to avoid faceup position. The oil was removed after approximately 6 weeks. Main Outcom e Measures: The authors considered the seal of the macular hole and th e preoperative and postoperative logarithm of the minimum angle of res olution (logMAR) visions the most significant measures for comparison to other studies. Results: Eighty percent of all holes and 86% of hole s not treated previously were sealed with a single silicone tamponade of the vitreous cavity. The logMAR value of visual acuity improved an average of 0.26 (2.6 lines) to 0.61 (20/81) for all eyes and 0.34 (3.4 lines) to 0.52 (20/66) when the macular hole sealed. Completeness of fill of the vitreous cavity with silicone affected seal of the macular hole. Three of eight eyes in which open holes developed after oil rem oval had less than 90% fill of the vitreous cavity by silicons. Sixty- nine percent of lenses increased opacity one grade or were removed aft er silicone tamponade. There were no significant adverse effects arisi ng from silicone tamponade. Conclusions: Silicone oil tamponade of mac ular holes is effective and safe. Silicone may be optimal for the trea tment of macular holes in persons who must travel, who cannot maintain facedown positioning, or who have monocular vision. The most importan t factor in the successful closure of the macular hole was the complet eness of fill of the vitreous cavity with silicone oil.