Postoperative Tamponade and Positioning Restrictions After Macular Hole Surgery

Indications of the surgical management of macular hole are based on the presence of a fullthickness defect (stage 2 or higher). Once this defect has developed, the potential for spontaneous resolution is low. Since the initial report by Kelly NE, the surgical technique of idiopathic macular hole has been improved (Kelly & Wendel, 1991). Currently, the most standard surgical technique for the treatment of idiopathic macular hole is pars plana vitrectomy with peeling of the internal limiting membrane and intraocular gas tamponade followed by prone positioning (Schaal et al., 2006). However, the mechanisms of macular hole closure have not been fully elucidated.There are two theories accounting for the process of macular hole closure and the role of the tamponade material. One is the buoyancy theory and the other is the isolation theory (Gupta, 2009). The buoyancy theory is based on the idea that the buoyancy force ‘presses’ the edges of the macular hole. Thus, prone positioning is considered necessary for closure of the macular hole. On the other hand, the isolation theory, which is also called ‘waterproofing’, is based on the idea that the