Table 4. Postoperative Management
Surgical and Postoperative Care Patient Education
• Inform the patient about risks associated
with use of expansile intraocular gas and
facedown positioning postoperatively.
(III, G, S)
• Instruct patients to promptly notify their
ophthalmologist if they have symptoms
such as an increase in floaters, a loss of
visual field, metamorphopsia, or a decrease
in visual acuity. (III, G, S)
• Formulate a postoperative care plan and
inform the patient of these arrangements.
(III, G, S)
• Inform patients that air travel, travel to
high altitudes, or general anesthesia with
nitrous oxide should be avoided until the
gas tamponade is nearly completely gone.
(III, G, S)
• Inform patients with glaucoma of possible
postoperative increase in IOP. (III, G, S)
• Inform patients who have had a
macular hole in one eye that they have
a 10%–15% chance of macular hole
formation in the fellow eye, especially if
the vitre ous remains attached. (III, G, S)
• Examine postoperatively within 1 or 2 days
and again 1–2 weeks after surgery.
(III, G, D)
• Refer patients with functionally limiting
postoperative visual impairment for vision
rehabilitation (see www.aao.org/
smart-sight-low-vision) and social services.
(II++, G, S)
Disclaimer
is Guideline attempts to define principles of practice that should produce high-quality patient care. It
is applicable to specialists, primary care practitioners, and providers at all levels. is Guideline should
not be considered exclusive of other methods of care reasonably directed at obtaining the same results.
e ultimate judgment concerning the propriety of any course of conduct must be made by the clinician
aer consideration of each individual patient situation. Neither IGC, the medical associations, nor the
authors endorse any product or service associated with the distributor of this clinical reference tool.
Abbreviations
FTMH, full-thickness macular hole; ICG, indocyanine green; ILM, internal limiting membrane;
IOP, intraocular pressure; OCT, optical coherence tomography; VMA, vitreomacular adhesion;
VMT, vitreomacular traction
Source
American Academy of Ophthalmolog y Retina/Vitreous Panel. Preferred Practice
Pattern
®
Guidelines. Idiopathic Macular Hole. San Francisco, CA: American Academy of
Ophthalmolog y; 2014. Available at: www.aao.org/ppp.
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