Optical coherence tomography-based positioning regimen for macular hole surgery

Purpose: To evaluate an optical coherence tomography (OCT)-based positioning regimen for patients undergoing macular hole surgery. Method: We reviewed the medical records of all patients in our practice who underwent macular hole repair, instituting a modified OCT-based positioning regimen from November 1, 2011 through July 31, 2013. The regimen consisted of prone positioning at the conclusion of surgery with daily OCT imaging until the hole was confirmed closed at which point positioning was halted. Clinical data that were collected and recorded included visual acuities, stage of hole, size of hole, chronicity, preoperative and postoperative OCT imaging, and length of follow-up. Results: We identified 33 patients (35 eyes) with a mean baseline visual acuity of 20/220, a mean hole size of 465 m. The mean final (postoperative) visual acuity was 20/135 with a mean follow-up of 7.7 months. Six patients (17%) in our study were diagnosed with myopic degeneration. Thirteen patients (37%) were found to have chronic (≥12 months) holes, and 19 (54%) were found to have large holes (>400 m). Overall, 28 eyes (80%) had persistent closure of macular holes with an OCT-based positioning regimen. In the absence of high risk factors, such as myopic degeneration, chronic or large holes, the closure rate was 92%. In the presence of 2 or 3 of these risk factors, the closure rate was 85% and 74%, respectively. Conclusion: The presence of 2 or 3 high risk factors, such as myopic degeneration, chronic holes (≥12 months), or large holes (>400 m) can compromise outcomes resulting in reopening after apparent early closure. Based on the presence of these risk factors, a modified postoperative positioning regimen can be used to obtain complete and persistent closure.