Intraocular tamponade duration and success of macular hole surgery

Purpose: The authors compare the success of macular hole surgery with a short duration tamponade using 5% perfluoropropane (C ₃F ₈), intermediate duration tamponade using 10% C ₃F ₈, or a long duration tamponade using 16% C ₃F ₈ in a prospective consecutive clinical trial at two institutions. Methods: Vitrectomy and fluid-gas exchange was performed in 29 eyes treated with 5% C ₃F ₈ and 1 week of prone positioning, 30 eyes treated with 10% C ₃F ₈ and 2 weeks of prone positioning, and 90 eyes treated with 16% C ₃F ₈ and 2 weeks of prone positioning 90% of time, followed by 2 weeks of prone positioning 50% of time. Results: The macular hole was closed successfully in 19 of 29 eyes (65.6%) treated with 5% C ₃F ₈, 19 of 30 eyes (63.3%) treated with 10% C ₃F ₈, and 85 of 90 eyes (94.4%) treated with 16% C ₃F ₈ at 3 months (P = 0.00017 for 5% vs. 16% C ₃F ₈, P = 0.00006 for 10% vs. 16% C ₃F ₈). The visual acuity improvements measured by refraction using the Early Treatment Diabetic Retinopathy Study (ETDRS) acuity charts paralleled the success of macular hole closure. The acuity improved a mean improvement of + 9.6 ETDRS letters for eyes treated with 5% C ₃F ₈, + 6.4 ETDRS letters for eyes treated with 10% C ₃F ₈, and + 13.1 ETDRS letters in eyes treated with 16% C ₃F ₈. Conclusions: A long duration intraocular gas tamponade with 16% C ₃F ₈ gives a substantially higher success rate for macular hole surgery than a short (5% C ₃F ₈) or intermediate duration (10% C ₃F ₈) intraocular gas tamponade.