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Christopher J. Compton, Dusty L. Pomerleau, Richard M. Feist, Jr., Lindsey R. Wallace, Richard M. Feist, Sr., Tracy L. Emond, John O. Mason, III, Martin L. Thomley, Michael A. Albert; Non-Supine Positioning is Preferred Over Face-Down Positioning and Provides an Equivalent Closure Rate in 25 and 23 gauge Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4487. doi: https://doi.org/.
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Face-down positioning after macular hole (MH) surgery has been thought necessary to achieve hole closure, but recent publications have called this into question. Our study seeks to determine if strict face-down positioning is necessary in 25 or 23 gauge macular hole repair and whether patients prefer short-term face-down or long-term non-supine positioning.
We reviewed all MH repairs by 4 surgeons in a single practice over a 3-year period (2006-2008). Inclusion criteria were preoperative documentation of patient demographics, lens status, macular hole diameter, and preoperative OCT, surgery with gas tamponade and ILM peeling, and follow up of 12 weeks or until complete hole closure. Patients were given a post operative survey about their positioning preference between strict face-down positioning for 7 days with a short-acting gas or non-supine positioning for 30 days with a long-acting gas.
A total of 52 eyes (52 patients) met inclusion criteria. All patients had 25 or 23 gauge vitrectomy with peeling of the ILM with closure in 50 of the 52 eyes. Thirty-one patients were instructed to position face-down at all times and 21 patients to merely avoid supine positioning. There was no significant difference in the positioning groups with respect to age, gender, MH diameter, central subfield thickness, total macular volume, preoperative or final visit visual acuity, hole closure rate, or duration of follow-up. Given the choice, 15 of 31 patients (47%) in the face-down group reported that they would prefer non-supine positioning for macular hole repair, even if longer positioning were required, versus all 21 patients in the non-supine group. Seventeen of 21 phakic patients (81%) in the face-down positioning group required cataract extraction before their final visit.
Non-supine positioning with a long-acting gas tamponade provides an equivalent MH closure rate to face-down positioning with a short-acting gas tamponade, and is preferable to most patients. Strict face-down positioning does not appear to significantly mitigate cataract formation.
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