Original article
Posturing Time after Macular Hole Surgery Modified by Optical Coherence Tomography Images: A Pilot Study

https://doi.org/10.1016/j.ajo.2008.09.028Get rights and content

Purpose

To see the early postoperative stage of macular hole (MH) surgery and to distinguish eyes needing prolonged posturing from those that do not use Fourier-domain optical coherence tomography (FD-OCT).

Design

Interventional case series.

Methods

Sixteen eyes of 15 patients with MH underwent the protocol at Kagoshima University Hospital. After the pars plana vitrectomy with 16% SF6 gas tamponade followed by posturing, the eyes were examined by FD OCT from 3 hours to the day after surgery. After MH closure was confirmed, posturing was stopped. Follow-up was performed for 4 months or longer. The main outcome measures included time and OCT finding of MH closure after surgery.

Results

On the day after surgery, the macula could be examined by FD-OCT in 13 of 16 eyes; 10 eyes had a closed MH and 3 had an unclosed MH. At day 2, 2 of the 3 eyes with unclosed MHs on day 1 demonstrated a closed MH. Posturing continued for 8 days in 4 eyes whose MH closure was not confirmed. The MH was closed in all eyes within 1 month. FD-OCT showed bridge formation of the neural retina in 9 eyes and simple closure in 3 eyes within 7 days. At 1 month, 12 eyes showed simple closure and 4 eyes showed bridge formation. Among 9 eyes with bridge formation within 7 days, 6 eyes had changed to simple closure at 1 month.

Conclusions

FD-OCT enabled confirmation of MH closure the day after surgery even in gas-filled eyes. This imaging method may be a good indicator to determine when to stop posturing for each patient.

Section snippets

Methods

All consecutive patients with idiopathic MH who agreed to participate in this study from March 1, 2007 through February 29, 2008 were enrolled and a prospective study was performed. Data collected included patient age and gender, MH stage (Gass classification) and latency (judged by clinical history), cataract grade of mild (nuclear sclerosis 1+) or moderate to advanced (nuclear sclerosis 2+ or 3+), and Snellen best-corrected visual acuity (BCVA) before and after surgery. Postoperative adverse

Results

The study included 16 eyes of 15 patients (7 eyes of 6 females and 9 eyes of 9 male). Age ranged from 54 to 78 years. Preoperative BCVA ranged from 20/400 to 20/30 (mean, 20/200). The possible latency period before surgery ranged from 0 to 9 months. All eyes were phakic. Four eyes had a stage 2 MH (25%), 10 eyes had a stage 3 MH (62.5%), and 2 eyes had a stage 4 MH (12.5%). These are summarized in Table 1. Sizes of MH ranged from 0.15 to 0.4 disc diameter.

Three hours after surgery, 5 eyes were

Discussion

Although the ocular fundus is observable even in a gas-filled eye by conventional TD-OCT, a detailed examination of the macular area is hampered by a strong light reflex. Kasuga and associates reported that 4 (58%) of 7 gas-filled eyes could be observed by TD-OCT on the day after surgery.25 However, findings of the posterior retina depicted by TD-OCT would not necessarily prove MH closure because the macula is not identifiable in a gas-filled eye by several scans of TD-OCT. Especially in the

Kyoko Masuyama, MD, graduated in 2005 from Kagoshima University School of Medical and Dental Sciences, Kagoshima, Japan. Dr Masuyama currently does her ophthalmology residency at the Department of Ophthalmology, Kagoshima University.

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    Kyoko Masuyama, MD, graduated in 2005 from Kagoshima University School of Medical and Dental Sciences, Kagoshima, Japan. Dr Masuyama currently does her ophthalmology residency at the Department of Ophthalmology, Kagoshima University.

    Taiji Sakamoto, MD, PhD, is the Professor and Chair, Department of Ophthalmology, Kagoshima University, Kagoshima, Japan. He completed residencies in Ophthalmology in 1985 and 1988 and fellowships in pathology at Kyushu University, Fukuoka, Japan. Dr Sakamoto was a lecturer of Doheny Eye Institute, University of Southern California, Los Angeles, California from 1992 to 1995. His research interests are ocular gene therapy, ocular neovascularization, and vitrectomy.

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