Vertical OCT can reduce face-down positioning in most macular hole patients
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VIENNA, Austria Unnecessarily long face-down positioning after macular hole surgery can be avoided by the use of a new vertical OCT technology, according to Claus Eckardt, MD.
"In most of the patients, the hole is fully closed within 24 hours, but examining the macula while the air is still in the eye is just not possible. The beam strikes the bubble tangentially, preventing visualization," he said at the Euretina Congress here. A solution would be to have the eye rotated, and this is only possible with the patient facing down.
The Topcon OCT has the capability for 90% angle rotation. In Dr. Eckardt's clinic, the device is mounted on a mobile armature, which allows examination from below with the patient in the prone position.
"We can visit the patient 24 hours postoperatively, and we have seen that the number of fully closed holes at this early time is much higher than expected. On the other hand, in most cases, if the hole is not closed at day 1, it will still not be at day 3," he said.
A series of 33 eyes was prospectively examined to establish OCT-based duration of face-down positioning. At 24 hours, 54% of the eyes showed a closed macular hole. Another series of 100 eyes showed that very large holes are closed within 1 day.
Dr. Eckardt said that simple air tamponade can result in 91% hole closure and allows vertical OCT at 24 hours. Longer lasting gases are not necessary.
"When you tell your patients that, most likely, they will not have to stay in the prone position for longer than 1 day, they feel a lot better and more motivated to follow the surgeon's instructions. After you have examined them at day 1, you can make an OCT-based decision on whether to prolong the duration, but all unnecessary cases will be avoided," he said.