Sulfur hexafluoride (SF6) versus perfluoropropane (C3F8) tamponade and short term face-down position for macular hole repair: a randomized prospective study.

Giamberto Casini,Paolo Radice,Pasquale Loiudice,Marco Nardi,Stefano De Cillà

doi:10.1186/s40942-016-0036-9

Abstract

BackgroundTo compare early visual and anatomical outcomes after either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) tamponade for macular hole repair.Methods147 eyes affected by primary full-thickness macular hole underwent pars plana vitrectomy with dye assisted removal of the internal limiting membrane and gas tamponade. Prone position was prescribed for 48 h after surgery. All patients were divided into 3 groups depending on the size of the hole: small (<250 µm), medium (>250–<400 µm) or large (>400 µm). Eyes within the same group randomly received either SF6 (70 eyes) or C3F8 (77 eyes). A complete ophthalmic evaluation, including best corrected visual acuity and anatomic status of the macular holes, was conducted preoperatively, at 1 week and 1 month after surgery. Macular hole volume was calculated using optical coherence tomography scans. The Wilcoxon Signed Ranks Test, the Mann–Whitney Test, the Spearman’s rank-order correlation coefficient and the study of variance for repeated measures were used for statistical analysis.ResultsMean best-corrected visual acuity improved from 0.92 logMAR to 0.28 logMAR (P < 0.001). A reduction of the dimensions of macular holes was observed in all cases, with a total repair of 90 % (63/70 eyes) in the SF6 group and 91 % in the C3F8 group (70/77 eyes). There was a negative correlation between the initial minor diameter, the volume of the hole and the rate of anatomic success.ConclusionsShort-term anatomical and visual outcomes were similar in eyes treated with either SF6 or C3F8, independently of the stage of the macular hole. The initial volume and the minor diameter of the hole may be considered as valid tools for predicting surgical success. Age and gender did not appear to have influenced the prognosis.

Highlights

To compare early visual and anatomical outcomes after either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) tamponade for macular hole repair
There is an adhesive interaction between the posterior vitreous cortex and the internal limiting membrane (ILM)
A spontaneous resolution, with hole closure and a restoration of the normal foveal contour, is very rare in full-thickness macular holes. It occurs in 2–4 % of the eyes [13, 14] these cases are usually treated surgically by pars plana vitrectomy, with or without peeling of the internal limiting membrane

Summary

Introduction

To compare early visual and anatomical outcomes after either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) tamponade for macular hole repair. A macular hole (MH) is a full thickness defect of the retinal neuroepithelium involving the fovea [1] It is idiopathic in most cases and is the result of a centrifuge. It has been clinically established that impending macular holes have a 50 % chance to evolve to a spontaneous closure with the resolution of symptoms [6] They are observed and not surgically treated. A spontaneous resolution, with hole closure and a restoration of the normal foveal contour, is very rare in full-thickness macular holes It occurs in 2–4 % of the eyes [13, 14] these cases are usually treated surgically by pars plana vitrectomy, with or without peeling of the internal limiting membrane

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