Combined pars plana lensectomy/vitrectomy for idiopathic macular hole repair without postoperative prone positioning

Abstract

Purpose The aim of this study is to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic macular hole (MH) without post-operative prone positioning (PPP).

Materials and Methods A retrospective chart review of 42 patients (47 eyes) with MH who underwent CPPLV was performed. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week. The main outcome measures included MH closure rate, best corrected post-operative Snellen visual acuity (BCVA), and procedure complications.

Results Anatomical closure was achieved in 44 eyes (93.6%). The average BCVA in these eyes improved from 20/203 at baseline to 20/91 post-operatively, with 28 (63.6%) having 20/40 or better. Twenty-eight (59.6%) of the 47 eyes had a BCVA of 20/40 or better post-operatively and 35 (74.5%) eyes improved by at least 2 Snellen lines. Post-operative retinal detachment (RD) was observed in 4 eyes (8.5%) and late reopening of the hole in 4 (9.1%).

Discussion The anatomical and visual outcomes and the RD rate of CPPLV with sulcus intraocular lens implantation without PPP are comparable to those of traditional MH surgery techniques. The main advantages include sparing the patient the inconvenience of PPP and eliminating the need for additional post-vitrectomy cataract extraction procedure.