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Nancy M. Holekamp, MD; Travis A. Meredith, MD; Maurice B. Landers, MD; William B. Snyder, MD; John T. Thompson, MD; Adrienne J. Berman, MD; Steven Williams, MD

Arch Ophthalmol. 1999;117:1607-1610.

Objective  To report a series of patients manifesting ulnar neuropathy as an extraocular complication following macular hole surgery and facedown positioning.

Methods  Retrospective chart review of 7 patients identified by the operating surgeon as developing ulnar neuropathy during the immediate postoperative period after undergoing vitrectomy surgery with fluid-gas exchange for macular hole followed by at least 1 week of strict facedown positioning.

Results  All 7 patients developed symptoms of ulnar neuropathy, including paresthesias, dysesthesias, pain, weakness, and muscle atrophy. Signs included abnormal electromyogram, prolonged nerve conduction velocities, and impaired neurologic clinical test results in patients examined. Symptoms did not resolve with cessation of facedown positioning, and with follow-up ranging from 3 to 24 months all patients had persistent symptoms. All patients had positioned themselves with their arms continuously flexed. Three of 7 patients had placed pressure directly on their bent elbows.

Conclusions  Ulnar neuropathy is an extraocular complication of macular hole surgery that can be attributed to arm position during postoperative facedown positioning. Surgeons performing macular hole surgery should caution their patients to minimize the amount of time spent with their elbows in a flexed position. Particular effort should be made to minimize pressure on the bent elbow.

From the Barnes Retina Institute, St Louis, Mo (Drs Holekamp, Meredith, and Berman); Retina and Vitreous Center, Virginia Beach, Va (Dr Landers); Texas Retina, Dallas (Dr Snyder); Retina Specialists, Baltimore, Md (Dr Thompson); and Mohawk Valley Retina, Utica, NY (Dr Williams).

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