All cases were performed via 3-port 23- or 25-gauge pars plana vitrectomy. Although it is technically easier to perform pars plana vitrectomy with shaving of the entire anterior-to-posterior vitreous base in a patient who is pseudophakic, we have found that it is within our capability, by having a surgical assistant depress the sclera, to shave the vitreous base in patients who are phakic. Our study found that phacoemulsification with intraocular lens insertion is not a crucial step in the process of repairing macular holes, as a significant proportion of the cases in our series were phakic at the time of surgery. Five holes had a basal diameter of larger than 1000 μm. Mean minimum linear dimension was 285 μm ☑36 μm. Mean hole basal diameter was 610 μm ☒26 μm. Fourteen percent of cases were referred to us with recurrent macular holes (n=9). Thirty-one percent of cases were stage 2 (n=21), 40% were stage 3 (n=27), and 29% were stage 4 holes (n=20). Sixty-five percent of cases were phakic (n=44) and 35% were pseudophakic (n=24). Seventy-one percent of surgeries in our series were performed in women (n=48) and 29% were performed in men (n=20). Although many studies excluded patients who had recurrent, myopic, or traumatic holes, we had no exclusions in our series. Our study, which reviewed patient records from March 2009 to December 2012, demonstrated noninferiority of no facedown positioning compared with prior published reports with facedown positioning. Previous studies using full, limited, or no facedown positioning for macular hole closure have reported varying degrees of success. Eliminating facedown positioning removes these obstacles. Patients who have researched macular hole surgery on the Internet often arrive in our office with a significant fear of facedown positioning. There are also patients who are physically incapable of maintaining facedown positioning due to musculoskeletal disorders or age. Additionally, patients who are hypercoagulable can develop deep vein thrombosis or pulmonary embolism. For example, facedown positioning has the potential to cause mesenteric venous obstructions. We have found clear benefits with regard to safety, comfort, and patient satisfaction. Subsequently, this technique has allowed several patients in our practice with macular holes of 16 to 20 years duration to undergo successful macular hole surgery that had been deferred due to unwillingness or inability to position facedown. The postoperative visual acuities were equivalent to those previously reported in the literature with facedown positioning. 1 In our case series, the single-procedure macular hole closure rate was 100% (95% CI, 95%–100%) and there were no reported complications. Some surgeons use silicone oil in those who cannot position, requiring an additional procedure to remove the oil, which carries its own risks.Ī recently published retrospective consecutive case series of patients from our practice (68 eyes in 65 patients) shows that macular hole surgery can be performed without facedown positioning with results equivalent to surgery in patients who practice facedown positioning. This is a significant source of morbidity for patients, however, as it is difficult and uncomfortable. doi:10.3341/ positioning for 3 days to 1 week after surgery for idiopathic macular hole repair remains the traditional standard of care. Lee EK, Yu HG.Outcomes of Anti-vascular Endothelial Growth Factor Treatment for Foveal Serous Retinal Detachment Associated with Inferior Staphyloma.Korean J Ophthalmol. 2019 Jun 33(3):228-237.Clinical and molecular markers in retinal detachment-From hyperreflective points to stem cells and inflammation.PLoS One. 2019 Jun 11 14(6):e0217548. Josifovska N, Lumi X, Szatmari-Tóth M, Kristóf E, Russell G, Nagymihály R et al.Risk Factors for Retinal Detachment: A Case-Control Study.
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