Combined 23-gauge, sutureless transconjunctival vitrectomy with phacoemulsification without face down posturing for the repair of idiopathic macular holes

Abstract

To evaluate the anatomical success and impact on visual acuity of 23-gauge, sutureless, phacovitrectomy, and intraocular gas tamponade for idiopathic macular hole surgery without face down posturing. This was a non-randomised, observational, retrospective trial during the period from September 2007 to September 2008 with data collection of 40 eyes from 39 consecutive patients who underwent transconjunctival, sutureless, 23-gauge vitrectomy (TSV 23G), phacoemulsification, internal limiting membrane (ILM) peel, and intraocular gas tamponade (16% C(2)F(6)) for stage 3 and 4 idiopathic macular holes. Patients were instructed to neither posture face down nor supine post-operatively. All procedures were performed by a senior, single surgeon (RR). The primary outcome measure was anatomical closure rate of the macular hole. Secondary outcome measure was improvement in visual acuity. Macular holes were flat closed in 37 (92.5%) eyes at the first attempt. The remainder were eventually closed with Oxane HD tamponade without the need for face down posturing. Post-operatively, 22 out of 40 (55%) patients achieved >2 lines improvement in Snellen, visual acuity; 12 out of 40 (30%) patients achieved a 1 line improvement in Snellen, visual acuity; and 5 out of 40 (12.5%) patients' visual acuities remained stable. One patient experienced a 1 line reduction in Snellen acuity owing to co-existing ocular surface disease. Given the well-known advantages of sutureless, vitrectomy and paucity of post-operative hypotony and endophthalmitis, we feel that the 23-gauge instrumentarium is the method of choice when combined with phacoemulsification for non-posturing, macular hole surgery.