Significance of face-down positioning after macular hole surgery with long-acting gas - consecutive case control study

Background: Postoperative face-down positioning is considered to be a criti cal part in macular hole surgery with short-acting gas. However, the signif icance of this posturing remains uncertain using long-acting gas tamponade. Patients and Methods: Fifty consecutive eyes with idiopathic full-thickness macular holes underwent macular hole surgery with a follow up time of 6-12 months. The results of a cohort (25 eyes) with complete C3F8 (16%) vitreou s fill without posturing was compared to a cohort (25 eyes) with SF6 (20%) with strict postoperative face-down positioning for two weeks. Results: With SF6 tamponade the anatomic success rate was 64%, in the C3F8 cohort a complete closure was achieved in 88%. In the SF6 cohort, visual re covery of three lines or better was attained in 44%, resulting in a visual acuity of 20/50 or better in 12%. The mean postoperative Visual acuity was 20/125 with a mean rise of 1.4 lines. In the C3F8 cohort, 72% improved for at least three lines with a mean postoperative visual acuity of 20/63 and a mean visual recovery of 3.3 lines. Visual acuity of 20/50 or better was no ted in 48% of eyes. Conclusion: The significantly higher success rate using C3F8 tamponade with out positioning compared to SF6 gas tamponade with positioning confirms the cumulative tamponade duration being a crucial factor in macular hole surge ry. Using a tamponade with short-acting gas only strict postoperative posit ioning ensures the contact of the gas bubble with foveal tissue and gains s ignificance with reducing bubble size. While a potential for significant Vi sual recovery in certain cases is evident, all in all a broad variability o f the postoperative success rate can be stated. In contrast, even in supine position C3F8 attains a continuous tamponade enforcing a sufficient glial wound healing without any positioning.