Is Face Down Positioning for Macular Hole Repair So Important?
December 9, 2009
As published in this month’s Graefes Arch Clin Exp Ophthalmol., face down positioning may be a thing of the past for successful repair of macular holes.
In a short retrospective study comparing patients with intraocular SF6 tamponade versus air, the closure rates were comparable, yet the time spent in the prone position was about half (7.4 versus 3.8 days) in the room air group. The size of the macular holes was not significant.
What Does This Mean? Closure of macular holes has been possible for the last 30 years. The use of intraocular gas varies among surgeons. Many use C3F8 which requires prone positioning for 2-3 weeks, while others (like me) use SF6 which requires prone positioning for about a week. The exact timing depends upon the mixture of the gas. I like to use 16% SF6.
The variance in gases and percentages used means to me that macular holes close very soon after surgery. There is something innately correct about tamponade and our surgical techniques that allow successful macular hole closure. I think it has little to do with the length of prone positioning.
Randall V. Wong, M.D.
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