The question arises what gas to use if I have macular hole surgery?  Also, does face-down positioning or posturing after macular hole surgery make a difference. 

A Cochrane review on the second question (face-down position) found the following. "We conducted a systematic review of outcomes for individuals with idiopathic macular holes following postoperative face-down positioning. We found three randomized controlled trials (RCTs). Two of the three trials suggested a benefit in holes larger than 400 microns in diameter. None demonstrated evidence of a benefit in smaller holes."

Large studies on the first question are lacking but the two articles below may be helpful.

In summary, the 2012 BJO article concluded: "Macular-hole surgery with SF(6) gas achieves similar results to C(2)F(6) and is absorbed faster, allowing quicker visual rehabilitation for the patient."  A recent paper from 2017 in Retina concluded "The macular hole closure rate was similar with sulfurhexafluoride and perfluoropropane, irrespective of hole size, stage, or duration. However, sulfurhexafluoride exhibited a decreased incidence of cataract and ocular hypertension with shorter tamponade duration. Perfluoropropane may have a role as the preferred endotamponading agent in failed primary surgeries.."

Br J Ophthalmol. 2012 Feb;96(2):185-8. doi: 10.1136/bjo.2010.201699. Epub 2011
May 17. Outcomes of sulfur hexafluoride (SF6) versus perfluoroethane (C2F6) gas tamponade
for non-posturing macular-hole surgery.

Rahman R(1), Madgula I, Khan K.

Author information: 
(1)Department of Ophthalmology, Calderdale Royal Hospital, Salterhebble, Halifax
HX3 0PW, UK. binarahman@fsmail.net

AIM: To compare the outcomes of non-posturing macular-hole surgery using sulfur
hexafluoride (SF(6)) gas versus perfluoroethane (C(2)F(6)) for idiopathic macular
hole repair. Design Interventional, comparative cohort study.
METHODS: 39 eyes of 38 patients undergoing macular-hole surgery with SF(6) were
compared with another consecutive group of 39 eyes (39 patients) in whom C(2)F(6)
was used. All patients were operated on by a single surgeon and underwent 23G
transconjunctival phakovitrectomy with no prone posturing in the postoperative
period. The best-corrected Snellen's visual acuity (VA) was converted to the
logarithm of minimal angle of resolution (logmar) visual acuity for analysis.
Optical coherence tomography documentation of anatomical closure and
complications of surgery were recorded.
RESULTS: Primary hole closure was achieved in 89.75% in the C(2)F(6) group and
87.2% in the SF(6) group. Secondary closure after non-posturing redo surgery with
heavy oil (Oxane-HD) was 100% in both groups. The mean preoperative VA in the
C(2)F(6) group and SF(6) group was 0.81 logMAR and 0.78 respectively. 2 weeks
after surgey, SF(6) was completely absorbed in all cases, and the mean VA
improved to 0.5 logMAR; however, it remained 1.9 logMAR in the C(2)F(6) group.
The final mean VA at 6 months was 0.44 (range 0-0.78) and 0.38 (range 0-1) in the
C(2)F(6) and SF(6) group respectively. There were no instances of pupillary
capture in the SF(6) group, whereas there were four in the C(2)F(6) group.
CONCLUSION: Macular-hole surgery with SF(6) gas achieves similar results to
C(2)F(6) and is absorbed faster, allowing quicker visual rehabilitation for the
patient.

DOI: 10.1136/bjo.2010.201699
PMID: 21586794  [Indexed for MEDLINE]

 

Retina. 2017 Feb;37(2):283-290. doi: 10.1097/IAE.0000000000001124.

SULFURHEXAFLUORIDE (SF6) VERSUS PERFLUOROPROPANE (C3F8) GAS AS TAMPONADE IN MACULAR HOLE SURGERY. Modi A(1), Giridhar A, Gopalakrishnan M.

Author information: 
(1)Vitreoretina Services, Giridhar Eye Institute, Cochin, India.

PURPOSE: To compare outcomes of macular hole surgery using sulfurhexafluoride
(SF6) versus perfluoropropane (C3F8) gas.
METHODS: This is a retrospective, interventional, comparative study. A total of
177 eyes of 166 patients operated over a 3-year period for idiopathic macular
holes were included. Sixty-seven eyes had tamponade with SF6 gas (Group 1),
whereas 111 eyes received C3F8 (Group 2) as the tamponading agent. The primary
outcome measure was the macular hole closure rate. Statistical analysis was done
using SPSSv16.
RESULTS: Spectral domain optical coherence tomography-based stagewise
distribution of macular holes were similar across both groups (P = 0.99). The
hole closure rate was 57/66 (86.4%) with SF6 and 96/111 (86.5%) with C3F8 gas (P
= 0.98). Subanalysis demonstrated no significant difference in closure rates
regarding macular hole size, stage, or duration. Best-corrected visual acuity
improved by a mean of 0.28 logMAR in the SF6 group (P = 0.00) and 0.42 logMAR in
the C3F8 group, corresponding to 3 lines and 4 lines of improvement,
respectively, on the Early Treatment Diabetic Retinopathy Study chart (P < 0.05).
The difference was not significant (P = 0.06). Rise in intraocular pressure was
higher in the C3F8 group (P < 0.05). Progression of cataract was also greater in
the C3F8 group (83.3 vs.73.9%), but it was not statistically significant (P =
0.20). Resurgery was done in 9/177 eyes. The closure rate with C3F8 and SF6
reinjections was 3/4 (75%) and 1/5 (20%). Moreover, anatomical hole closure after
resurgeries was better in Group 1 (4/5 eyes) than in Group 2 (0/4 eyes).
CONCLUSION: The macular hole closure rate was similar with sulfurhexafluoride and
perfluoropropane, irrespective of hole size, stage, or duration. However,
sulfurhexafluoride exhibited a decreased incidence of cataract and ocular
hypertension with shorter tamponade duration. Perfluoropropane may have a role as
the preferred endotamponading agent in failed primary surgeries.

DOI: 10.1097/IAE.0000000000001124
PMID: 28118283 

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