No face-down positioning and broad internal limiting membrane peeling for idiopathic macular holes

Objective To demonstrate the efficacy of broad internal limiting membrane(ILM) peeling and 16% perfluoropropane(C3F8) endotamponade with no face-down positioning in the surgical repair of idiopathic macular holes(IMH). Methods A total of 63 patients(63eyes) in our hospital from March 2010 to January 2013 recruited in this study. All IMH surgeries were operated by same one surgeon,broad ILM peeling,16% C3F8 endotamponade with no facedown positioning were performed. Surgeon method included 23-gauge pars plan vitrectomy. Indocyanine green dye(0. 08 g·L- 1) was injected slowly,allowed to stain for 1 minute,and then removed. ILM was broadly peeled to the vascular arcades( approximately 8000 μm in diameter),followed by 2 fluideair exchanges,separated by 5 minutes,and the air-16% C3F8 exchanged. Patients maintained reading position for 3 days to 5 days and were followed up at least for 6 months.Results Eight patients(12. 70%) had recurrent IMH,and mean duration from previous surgery was(1. 3 ± 2. 1)years,ranged from 1 year to 3 years. 20 cases(31. 75%) were in stage 2,21cases(33. 33%) in stage 3,and 22 cases(34. 92%) in stage 4. IMH basal diameter was(517.63 ± 258. 27)μm,and four IMH had a basal diameter of more than 1000 μm. The preoperative BCVA was 0. 16 ± 0. 18,and the postoperative BCVA was 0. 27 ± 0. 15. The single-procedure IMH closure rate was 100%,and no serious complication was observed. Conclusion Macular hole surgery with broad ILM peeling,16% C3F8 gas,and no face-down positioning is more effective in the surgical treatment of IMH compared with gas endotamponade and face-down positioning.