Abstract
This study evaluated changes in intraocular pressure (IOP) with face-down positioning (FDP) following surgical treatment of idiopathic macular hole. We retrospectively reviewed the records of 130 patients diagnosed with idiopathic macular hole who underwent pars plana vitrectomy (PPV) with intravitreal gas injection after fluid-gas exchange. We analyzed IOP changes in both eyes following FDP over the course of 7 days. The mean IOP of the operated eyes was 14.98±2.95 mmHg preoperatively and 16.82±3.12 and 15.57±6.10 mmHg on postoperative days 2 and 7, respectively. In contralateral eyes, the mean IOP changed from 14.78±3.15 mmHg preoperatively to 16.27±1.87 and 14.40±4.14 mmHg on postoperative days 2 and 7, respectively. On postoperative day 2, the IOP increased in both eyes compared to the preoperative values, but the increase was significant only in operated eyes (p = 0.039). In contralateral eyes, the IOP on postoperative day 7 was significantly decreased compared with that on postoperative day 2 (p = 0.021) and in eyes with an axial length ≥ 23.0 mm, compared with the preoperative values (p = 0.042). The IOP of the operated eyes on postoperative day 7 was higher than that of the contralateral eyes (p = 0.039). Based on a short-term follow-up, FDP after PPV with intravitreal gas tamponade for the treatment of idiopathic macular hole may cause IOP elevation not only in the operated, but also in the contralateral eyes; the IOP increase in contralateral eyes was not as significant as that in operated eyes and was not maintained over 7 days after surgery; the IOP change seems to be affected by axial length and lens status.
Highlights
Idiopathic macular hole is a full-thickness defect of the retinal neurosensory layer caused by vitreous traction
A total of 130 patients who were diagnosed with monocular idiopathic macular hole and underwent surgical treatment were enrolled in this study
There was no significant difference in the preoperative axial length or intraocular pressure (IOP) between phakic and pseudophakic eyes
Summary
Idiopathic macular hole is a full-thickness defect of the retinal neurosensory layer caused by vitreous traction. Pars plana vitrectomy (PPV) combined with intravitreal gas tamponade and internal limiting membrane peeling is considered the standard treatment [1]. Since Kelly and Wendel [2] reported that face-down positioning (FDP) was necessary following macular hole surgery, it has become a routine postoperative procedure. Even though there is increasing evidence that short-term or no FDP may be effective, occasional cases were believed to need long-term FDP to close macular holes [3,4,5]. Regardless, controversy exists concerning its necessity and duration as FDP may induce complications, such as intraocular pressure.
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