Î The surgeon should instruct the patient about the need for intraocular gas,
facedown positioning postoperatively to tamponade the hole, as well as the
likely development of a cataract in phakic eyes. (III, G, S)
Î Patients with glaucoma should be informed of the possibility of an
increase in postoperative intraocular pressure (IOP). (III, G, S)
Surgery
Î An important anatomic goal of the pars plana vitrectomy is to separate the
posterior cortical hyaloid from the retinal surface.
Î Triamcinolone acetonide can be injected into the vitreous following a core
vitrectomy to highlight the posterior vitreous.
Î Retinal tamponade may be created using different agents at the conclusion
of macular hole surgery in order to achieve anatomic closure of the
macular hole. (III, M, D)
Î Tamponade options include the use of air (days), SF
6
(2– 4 weeks), C
3
F
8
(1–3 months), or silicone oil (long-term). (II-, M, D)
Î Silicone oil may be used for patients who cannot position facedown, but
visual results are better with gas tamponade. (II-, M, D)
Î Using silicone oil also requires a second operation for oil removal. (III, G, S)
Î No firm recommendations can be made regarding the role of internal
limiting membrane (ILM) peeling. (II-, In, D)
Î When the surgeon prefers indocyanine green (ICG) to stain the ILM, the
lowest possible concentration of ICG should be used. (III, G, S)
Î There is no clear consensus for the duration of facedown positioning to
seal macular holes following vitrectomy surgery. Longer positioning may
be required for holes >400 µm or those with inadequate tamponade.
(I+, G, D)
Î Follow-up recommendation for Stage 3–4 macular holes treated by
vitreoretinal surgery: 1–2 days postoperatively, then 1–2 weeks, depending
on the outcome of surgery and the patient's clinical course. (III, G, D)
Postoperative Management
Î The surgeon is responsible for formulating a postoperative care plan and
should inform the patient of these arrangements. (III, G, S)
