Non-Posturing Macular Hole Surgery with Choice of Tamponade Guided by Hole Base Diameter

Purpose: Post-operative posturing and choice of intraocular tamponade remain contentious issues in macular hole surgery. We report the results of non-posturing surgery, with choice of tamponade guided by macular hole size. Methods: In this retrospective consecutive case series, patients underwent non-posturing 23G vitrectomy/phacovitrecomy and ILM peel for idiopathic full-thickness macular holes. Pre-operative hole base diameter was measured using spectral domain OCT. Macular holes with a base diameter (BD) of ≤ 720 μm were tamponaded with 20% SF6 (Sulfur hexafluoride), while larger holes received 20% C2F6 (perfluoro-ethane). The primary hole closure rate and improvement in vision was recorded. Results: 58 eyes in the SF6 group had a mean macular hole base diameter of 504.8μm (range 95-733μm). 28 eyes in the C2F6 group had a mean macular hole BD of 963.0μm (range 722-1440μm). The primary surgical success rate was 93.5% in the SF6 group and 92.9% in the C2F6 group. Using a Z-test for the equality of two proportions, the proportions of successful procedures in cases with SF6 and C2F6 agents were found to be not significantly different (Z=0.122; p=0.903). Conclusion: Short acting SF6 gas and medium acting C2F6 gases were effective in closing macular holes with an average preoperative macular hole BD of 504.8 μm and 963.0 μm respectively. Further studies are required to determine, the optimum tamponade guided by preoperative macular hole size