Abstract
Purpose: :
To compare strict postoperative face down positioning (FDP) with no FDP in the repair of macular hole (MH).
Methods: :
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.
Results: :
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.
Conclusions: :
The findings indicate that no postoperative FDP is equally as effective as strict postoperative FDP in the repair of MH.
Keywords: macular holes • vitreoretinal surgery • retina