News reports from the conference

Dramatic shortening of face-down time following macular hole surgery possible

The requirement for patients to spend up to two weeks in a face-down position following macular hole surgery, has been challenged by the findings of a study conducted by researchers from Queen's University in Kingston, Ontario.

Ophthalmology resident Dr. David Almeida presented results from a prospective case series showing that short-duration, three-day face-down positioning following surgery resulted in satisfactory anatomic and vision-related quality-of-life (VRQOL) outcomes.

Almeida said that, while patients are instructed to adhere to strict face-down positioning for one to two weeks following macular-hole surgery, compliance is known to be poor, with up to only half of all patients adhering to the required positioning. According to Almeida, the evolution of the surgical technique, including the use of shorter-acting gas tamponade, suggests that such strict requirements are no longer needed to achieve the exceptionally high hole closure rates that are now being achieved. He notes, however, that this remains an "uncertain and controversial issue."

To test the effectiveness of a shorter period of face-down positioning, the researchers evaluated anatomic outcomes in 50 eyes in 50 patients, and VRQOL in 20 eyes in 19 patients who underwent macular hole surgery. VRQOL was assessed using the National Eye Institute Visual Function Questionnaire 25.

Patients were all adults with symptoms of less than one-year duration with stage 2 and 3 idiopathic macular holes. Patients underwent core vitrectomy and detachment of the posterior hyaloid, meticulous macular internal limiting membrane (ILM) peeling and air-gas exchange with 20% SF6. All were instructed to remain in a face-down position for three days following surgery.

Closure was achieved in 49 of 50 eyes with one surgery, Almeida noted; the other eye was successfully treated with a more extensive intervention. He said that this is one of the most successful surgery rates reported. Two complications were reported - cystoid macular edema in one eye and intraocular lens (IOL) pupillary capture in one eye.

A significant improvement in post-operative VRQOL was also noted compared with pre-operative scores.

Other members of the research team were Drs. Jaspreet Rayat, Jonathon Wong, Michel Belliveau and Jeffrey Gale. The study was done in conjunction with Drs. Eric Olson, Mark Donaldson, Sophie Bakri, Jose Pulido and Donna Mueller.