Szurman P, Di Tizio F M, Lafaut B, Aisenbrey S, Grisanti S, Roters S, Bartz-Schmidt K U
Universitäts-Augenklinik Köln, Joseph-Stelzmann-Str. 9, Köln.
Klin Monbl Augenheilkd. 2000 Dec;217(6):351-5. doi: 10.1055/s-2000-9574.
Postoperative face-down positioning is considered to be a critical part in macular hole surgery with short-acting gas. However, the significance of this posturing remains uncertain using long-acting gas tamponade.
Fifty consecutive eyes with idiopathic full-thickness macular holes underwent macular hole surgery with a follow up time of 6-12 months. The results of a cohort (25 eyes) with complete C3F8 (16%) vitreous fill without posturing was compared to a cohort (25 eyes) with SF6 (20%) with strict postoperative face-down positioning for two weeks.
With SF6 tamponade the anatomic success rate was 64% in the C3F8 cohort a complete closure was achieved in 88%. In the SF6 cohort, visual recovery of three lines or better was attained in 44%, resulting in a visual acuity of 20/50 or better in 12%. The mean postoperative visual acuity was 20/125 with a mean rise of 1.4 lines. In the C3F8 cohort, 72% improved for at least three lines with a mean postoperative visual acuity of 20/63 and a mean visual recovery of 3.3 lines. Visual acuity of 20/50 or better was noted in 48% of eyes.
The significantly higher success rate using C3F8 tamponade without positioning compared to SF6 gas tamponade with positioning confirms the cumulative tamponade duration being a crucial factor in macular hole surgery. Using a tamponade with short-acting gas only strict postoperative positioning ensures the contact of the gas bubble with foveal tissue and gains significance with reducing bubble size. While a potential for significant visual recovery in certain cases is evident, all in all a broad variability of the postoperative success rate can be stated. In contrast, even in supine position C3F8 attains a continuous tamponade enforcing a sufficient glial wound healing without any positioning.
术后俯卧位被认为是短效气体黄斑裂孔手术的关键环节。然而，使用长效气体填塞时这种体位的重要性仍不明确。
连续50只患有特发性全层黄斑裂孔的眼睛接受了黄斑裂孔手术，随访时间为6至12个月。将一组（25只眼）使用C3F8（16%）玻璃体填充且未采取体位的患者结果与另一组（25只眼）使用SF6（20%）并在术后严格俯卧位两周的患者结果进行比较。
使用SF6填塞时，C3F8组的解剖成功率为64%，88%实现了完全闭合。在SF6组中，44%的患者视力提高了3行或更多，12%的患者视力达到20/50或更好。术后平均视力为20/125，平均提高了1.4行。在C3F8组中，72%的患者至少提高了3行，术后平均视力为20/63，平均视力提高了3.3行。48%的眼睛视力达到20/50或更好。
与使用SF6气体填塞并采取体位相比，使用C3F8填塞且不采取体位的成功率显著更高，这证实了累积填塞持续时间是黄斑裂孔手术的关键因素。仅使用短效气体填塞时，严格的术后体位可确保气泡与黄斑组织接触，并且随着气泡尺寸减小其重要性增加。虽然在某些情况下明显有显著视力恢复的可能性，但总体而言术后成功率存在很大差异。相比之下，即使在仰卧位，C3F8也能实现持续填塞，促进足够的胶质伤口愈合，无需任何体位。
