Stellenwert der postoperativen positionierung in der chirurgie des idiopathischen makulaforamens - Kontrollierte konsekutive studie

Background: Postoperative face-down positioning is considered to be a critical part in macular hole surgery with short-acting gas. However, the significance of this posturing remains uncertain using long-acting gas tamponade. Patients and Methods: Fifty consecutive eyes with idiopathic full-thickness macular holes underwent macular hole surgery with a follow up time of 6-12 months. The results of a cohort (25 eyes) with complete C₃F₈ (16 %) vitreous fill without posturing was compared to a cohort (25 eyes) with SF₆ (20%) with strict postoperative face-down positioning for two weeks. Results: With SF₆ tamponade the anatomic success rate was 64%, in the C₃F₈ cohort a complete closure was achieved in 88%. In the SF₆ cohort, visual recovery of three lines or better was attained in 44%, resulting in a visual acuity of 20/50 or better in 12%. The mean postoperative visual acuity was 20/125 with a mean rise of 1.4 lines. In the C₃F₈ cohort, 72% improved for at least three lines with a mean postoperative visual acuity of 20/63 and a mean visual recovery of 3.3 lines. Visual acuity of 20/50 or better was noted in 48% of eyes. Conclusion: The significantly higher success rate using C₃F₈ tamponade without positioning compared to SF₆ gas tamponade with positioning confirms the cumulative tamponade duration being a crucial factor in macular hole surgery. Using a tamponade with short-acting gas only strict postoperative positioning ensures the contact of the gas bubble with foveal tissue and gains significance with reducing bubble size. While a potential for significant visual recovery in certain cases is evident, all in all a broad variability of the postoperative success rate can be stated. In contrast, even in supine position C₃F₈ attains a continuous tamponade enforcing a sufficient glial wound healing without any positioning.