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    Research offers insights to success in macular hole surgery



    Tamponade techniques, prone positioning

    Dr. Thompson said visual results from several studies support the use of gas rather than silicone oil for tamponade. However, silicone oil is used for difficult macular holes.

    For prone positioning, there has been a trend toward a shorter duration. Data from the 2015 Preferences and Trends Survey of the American Society of Retina Specialists showed that the majority of American respondents were recommending ≤7 days, with the largest group (47.6%) recommending 5 to 7 days.

    OCT image of a stage 2 macular hole of recent onset. Courtesy of John T. Thompson, MD

    Dr. Thompson said the short-duration, prone positioning for a several days can be used with a shorter-acting gas bubble, either air or sulfurhexafluoride (SF6), but the longer-acting gas, perfluoropropane (C3F8), is needed if prone positioning is not done.

    “An analysis of 2,456 eyes in a New Zealand registry found SF6 was non-inferior to C3F8 for holes ≤400 µm, but the researchers could not conclude that SF6 was not non-inferior to C3F8 for larger holes,” Dr. Thompson said, adding that C3F8 is best used in pseudophakic eyes because of its associated risk for causing a gas-induced cataract with short-duration prone positioning.

    Whether using SF6 or C3F8, a large fill (>80%) is necessary in the first postoperative day to maintain coverage over the macular hole, regardless of gaze and body position.

    Japanese report


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