Face-down positioning versus non-supine positioning in macular hole surgery

• Published in: British journal of ophthalmology Vol. 99; no. 2; pp. 236 - 239
• Main Authors: Alberti, Mark, la Cour, Morten
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2015
• Subjects: Aged; Basement Membrane - surgery; Biomedical research; Cataracts; Compliance; Diabetes; Diabetic retinopathy; Endotamponade; Eye surgery; Female; Fluorocarbons - administration & dosage; Gases; Humans; Male; Middle Aged; Prone Position; Pseudophakia - complications; Questionnaires; Retinal Perforations - physiopathology; Retinal Perforations - surgery; Retrospective Studies; Statistical analysis; Studies; Surgery; Surgical techniques; Surveys and Questionnaires; Tomography, Optical Coherence; Visual Acuity - physiology; Vitrectomy; Macula; Treatment Surgery
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2014-305569

Aim To evaluate the full thickness macular hole (FTMH) closure rate in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). Methods We retrospectively reviewed two FTMH case series—postoperative positioning was FDP and NSP, respectively. All eyes were pseudophakic and treatment consisted of pars plana vitrectomy, internal limiting membrane peeling and perfluoropropane gas tamponade. Primary outcome measure was FTMH closure verified by optical coherence tomography. Secondary outcome was ETDRS visual acuity 6 months postoperatively. Results Over 13.7 months 122 eyes were included in this study, 66 eyes in the FDP group and 56 eyes in the NSP group. Closure rates were 95.5% and 96.4% in the FDP group and the NSP group, respectively. Median postoperative visual acuity at 6 months was 69 ETDRS letters in both positioning groups (p=0.64). Neither positioning group fully complied with the recommended positioning protocol. Conclusions Results from consistent FTMH repair indicate similar anatomical success rates in FDP and NSP groups, suggesting that FDP is unnecessary. Objective monitoring of positioning would be beneficial in future FTMH studies to be able to adjust for positioning protocol compliance.