Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery.

Abstract

PURPOSE:

The purpose of this study was to compare the efficacy of short-term non-supine positioning (NSP) and strict face-down positioning (FDP) in the repair of macular hole (MH).

METHODS:

We retrospectively reviewed all MH repairs over a 27-month period (2008-2010). Inclusion criteria were idiopathic full thickness stage 2-4 MH treated by a single surgeon with 23-gauge pars plana vitrectomy, internal limiting membrane peeling and gas tamponade, followed by postoperative short-term NSP (for 5 days) or strict FDP (for 3-4 days). NSP was achieved by fastening a tennis ball to the back of the nightshirt. Outcome measures were anatomical MH closure verified by optical coherence tomography and postoperative visual acuity.

RESULTS:

A total of 67 eyes (64 patients) met the inclusion criteria. The median follow-up period was 6.6 months (range, 4.7-19.8 months). The closure rates following a single operation were 30/33 (90.9%) in the FDP group, and 31/34 (91.2%) in the NSP group, respectively (p = 0.97). The FDP group improved 2.9 ETDRS lines, and 23 eyes (69.7%) gained two or more ETDRS lines. The NSP group improved 2.7 ETDRS lines (p = 1.00), and 25 eyes (73.5%) gained two or more ETDRS lines. The closure rates in the MH subgroup with diameters larger than 400 μm were 20/23 (87.0%) and 15/17 (88.2%) in the FDP group and the NSP group, respectively (p = 0.96).

CONCLUSION:

The study indicates that short-term NSP is equally effective as strict FDP in the repair of MH. Contrary to previous reports, even large MH did not seem to benefit from FDP.

• Authors: Vegard Asgeir Forsaa, Sten Raeder, Laila Tjelta Hashemi, Jørgen Krohn
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 91 Issue 6 Pg. 547-51 (Sep 2013) ISSN: 1755-3768 [Electronic] England
• PMID: 22830524 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Chemical References

• Fluorocarbons
• perflutren
• Sulfur Hexafluoride

Topics

• Aged
• Basement Membrane (surgery)
• Endotamponade
• Female
• Fluorocarbons (administration & dosage)
• Follow-Up Studies
• Humans
• Male
• Patient Positioning (methods)
• Postoperative Period
• Prone Position
• Retinal Perforations (diagnosis, physiopathology, surgery)
• Retrospective Studies
• Sulfur Hexafluoride (administration & dosage)
• Time Factors
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity (physiology)
• Vitrectomy