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)
