Combined 23-gauge, sutureless transconjunctival vitrectomy with phacoemulsification without face down posturing for the repair of idiopathic macular holes.

OBJECTIVE: To evaluate the anatomical success and impact on visual acuity of 23-gauge, sutureless, phacovitrectomy, and intraocular gas tamponade for idiopathic macular hole surgery without face down posturing.
METHODS: This was a non-randomised, observational, retrospective trial during the period from September 2007 to September 2008 with data collection of 40 eyes from 39 consecutive patients who underwent transconjunctival, sutureless, 23-gauge vitrectomy (TSV 23G), phacoemulsification, internal limiting membrane (ILM) peel, and intraocular gas tamponade (16% C(2)F(6)) for stage 3 and 4 idiopathic macular holes. Patients were instructed to neither posture face down nor supine post-operatively. All procedures were performed by a senior, single surgeon (RR). OUTCOME MEASURES: The primary outcome measure was anatomical closure rate of the macular hole. Secondary outcome measure was improvement in visual acuity.
RESULTS: Macular holes were flat closed in 37 (92.5%) eyes at the first attempt. The remainder were eventually closed with Oxane HD tamponade without the need for face down posturing. Post-operatively, 22 out of 40 (55%) patients achieved >2 lines improvement in Snellen, visual acuity; 12 out of 40 (30%) patients achieved a 1 line improvement in Snellen, visual acuity; and 5 out of 40 (12.5%) patients' visual acuities remained stable. One patient experienced a 1 line reduction in Snellen acuity owing to co-existing ocular surface disease.
CONCLUSION: Given the well-known advantages of sutureless, vitrectomy and paucity of post-operative hypotony and endophthalmitis, we feel that the 23-gauge instrumentarium is the method of choice when combined with phacoemulsification for non-posturing, macular hole surgery.