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The Effect of Postoperative Face-Down Positioning and of Long- versus Short-Acting Gas in Macular Hole Surgery

Results of a Registry-Based Study
Published:February 23, 2016DOI:https://doi.org/10.1016/j.ophtha.2015.12.039

      Purpose

      To determine whether sulfur hexafluoride (SF6) gas is noninferior to longer-acting gases in macular hole surgery and whether withholding postoperative face-down positioning (FDP) is noninferior to FDP.

      Design

      Registry-style, prospective, nonrandomized, observational cohort study.

      Participants

      Patients with idiopathic macular holes undergoing primary surgery.

      Methods

      Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information were collected, as well as details of surgical intervention and postoperative posturing advice. Primary follow-up data were collected 3 months postoperatively.

      Main Outcome Measures

      Macular hole closure at 3 months. A noninferiority approach was used, with a noninferiority margin set at 5% decreased frequency of success.

      Results

      A total of 2456 eyes of 2367 patients were included in the study. Outcomes were available in 94.9% of cases (2330/2456). The rate of macular hole closure was 95.0% (2214/2330). Sulfur hexafluoride gas was found to be noninferior to longer-acting gases (95% confidence interval [CI] for adjusted effect on success, −1.76 to +2.25), and noninferiority was demonstrated regardless of macular hole size. Although withholding FDP was found to be noninferior to FDP for the study population as a whole (95% CI for adjusted effect on success, −4.21 to +0.64), the result was inconclusive in holes >400 μm in diameter (95% CI, −9.31 to +1.04). Lack of internal limiting membrane (ILM) peel, increasing hole size, hole duration ≥9 months, increasing age, and 20-gauge surgery all were associated with lower odds of success. Vitreous attachment to the hole margin was not associated with outcome when corrected for hole size, and combined phacovitrectomy surgery was not observed to affect the odds of success in phakic eyes.

      Conclusions

      Sulfur hexafluoride gas tamponade was noninferior to longer-acting gases in the surgical management of macular hole. Withholding FDP was noninferior to FDP in holes ≤400 μm in diameter. In holes >400 μm in diameter, noninferiority of withholding FDP could not be concluded. We would advise caution if posturing is withheld in this group on the basis of the results of this study and of others.

      Abbreviations and Acronyms:

      CI (confidence interval), C3F8 (perfluoropropane), FDP (face-down positioning), ILM (internal limiting membrane), SF6 (sulfur hexafluoride)
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      Linked Article

      • Corrigendum
        OphthalmologyVol. 124Issue 6
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          The authors of “The effect of postoperative face-down positioning and of long- versus short-acting gas in macular hole surgery” (Ophthalmology. 2016;123:1129-1136) identified errors during a retrospective source data verification process as part of the preparation of a subsequent manuscript. The authors wish to correct the following error in their data:
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