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Idiopathic Macular Hole

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Management Follow-up Care Î Patients who have surgery are usually examined on postoperative day 1 or 2 and again approximately 1–2 weeks following surgery. The frequency and timing of subsequent postoperative visits varies, depending on the outcome of surgery and the patient's symptoms. (III, G, D) Î The follow-up visit should include: • interval history, including new symptoms (III, G, S) • measurement of IOP (III, G, S) • measuring visual acuity (III, G, S) • slit-lamp biomicroscopy of the anterior chamber and central retina, and indirect binocular ophthalmoscopy of the peripheral retina (III, G, S) • OCT to document the postoperative macular anatomy (III, G, S) Further Surgical Comments Î With the high rate of cataract formation and risk of reopening of the macular hole, some surgeons advocate combining macular hole surgery with phacoemulsification and placement of an intraocular lens. (III, M, D) Î Patients who have retinal tamponade achieved by an intravitreal gas bubble must avoid air travel and higher altitude travel. They must be informed about the implications of such travel for the postoperative gas-filled eye. (III, G, S) Î Most surgeons require their patients to wear a wristband warning alert that states that the eye contains intraocular gas, and anesthetic such as nitrous oxide should be avoided and may result in a dangerous rise in IOP. (III, G, D) Î It is unknown whether surgeon awareness to minimize prolonged air flow at high pressure has reduced the incidence of visual field loss after macular hole surgery. (III, In, D) Î It is unknown whether secure closure of the sclerotomies to minimize air flow through the eye during the air-fluid exchange has reduced the incidence of visual field loss after macular hole surgery. (III, In, D) Î It is unknown whether leaving a puddle of fluid posteriorly until the final aspiration has reduced the incidence of visual field loss after macular hole surgery. (II-, In, D) Î It is unknown whether humidifying the air has reduced the incidence of visual field loss after macular hole surgery. (II-, In, D) Î It is unknown whether using a low infusion pressure during air-fluid exchange has reduced the incidence of visual field loss after macular hole surgery. (II-, In, D)

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