Macular hole surgery with air tamponade

We used a specially designed optical coherence tomography (OCT) device to investigate the dynamics of early macular hole closure after vitrectomy with air tamponade and to determine the closure rate and the briefest possible prone positioning. A total of 112 patients with macular holes were examined using a modified spectral-domain OCT on days 1, 2 and 3 after vitrectomy with air tamponade. As soon as closure was complete (group one) or partial (hole closed at inner retinal layers but outer retinal layers still detached from pigment epithelial layer, group two), prone positioning was ended. If neither partial nor complete closure was observed by the third day, renewed vitrectomy was performed on postoperative days 4-8. Macular hole closure was achieved in 88 of the 112 eyes (79%). In 35 of the 88 eyes partial closure was noted on the first postoperative day. In 20 of the 24 eyes requiring renewed surgery the hole was finally closed. After a median follow-up of 144 days the macular hole was completely closed in all layers in 108 patients (96%). Mean visual acuity at final follow-up was 0.37 logMAR in group one, 0.29 logMAR in group two and 0.51 logMAR in patients whose holes closed after renewed surgery. Once closed, none of the macular holes reopened. The 79% initial closure rate in the present study is about 10% lower than that reported in other studies employing long-acting gas tamponades. However, renewed surgery with air tamponade achieved a closure rate of 96%. Early partial closure is sufficient for subsequent complete closure, requires no further tamponade or prolonged prone positioning, and has no negative effect on the functional results. Short-term prone positioning is sufficient for most patients.