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Vegard A. Forsaa, Laila T. Hashemi, Sten Raeder, Joergen Krohn; Strict Face Down Positioning Compared With No Face Down Positioning In The Repair Of Macular Hole. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4492.
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To compare strict postoperative face down positioning (FDP) with no FDP in the repair of macular hole (MH).
A total of 74 consecutive patients underwent surgical repair of MH at Stavanger University Hospital, Norway, over a 27-month period (July 2, 2008 - November 10, 2010). All surgeries were carried out by a single surgeon (VAF). The initial 37 patients were subjected to a strict hospitalized postoperative FDP for 3 days (stage 4 MH; 4 days), whereas the following 37 patients received no postoperative FDP. For a period of 5 postoperative days the patients in the non-FDP group were instructed not to gaze upwards or sleep on their back. The latter was achieved by fastening a tennis ball to the back of the nightshirt. A complete 23-gauge pars plana vitrectomy followed by internal limiting membrane peeling and gas tamponade were applied. Follow-up data were collected at the visit closest to 3 months postoperatively. Closed MH was defined as anatomical closure verified by optical coherence tomography. Mann-Whitney U test and Chi-Square test were used to compare the groups.
No statistically significant differences were found on age, gender, and staging of macular hole. In the FDP group mean age was 68.0 years, 75.7% were females, 6 (16.2%) stage 2 MH, 21 (56.8%) stage 3 and 10 (27.0%) stage 4. In the non-FDP group mean age was 72.1 years, 75.7% were females, 11 (29.2%) stage 2 MH, 16 (43.2%) stage 3 and 10 (27.0%) stage 4. Preoperative visual acuity (VA) in the FDP group was logMAR 0.73 compared to 0.75 in the non-FDP group (p=0.41). Mean FDP was 3.24 days. The mean follow-up period was 79.7 days and 53.3 days in the FDP and the non-FDP group, respectively. Closure rates after one surgery were 33/37 (89.2%) in both groups. Patients in the FDP group improved 9.5 ETDRS letters compared with 6.2 (p=0.24) in the non-FDP group.
The findings indicate that no postoperative FDP is equally as effective as strict postoperative FDP in the repair of MH.
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