Prospective Randomized Clinical Trial Comparing Five–Day Face Down Position and Semi Seated Position After Surgery for Idiopathic Full–Thickness Macular Hole (MH): Preliminary Results

Abstract

Purpose: : To determine the influence of face down position on anatomic and functional results after macular hole surgery.

Methods: : This prospective randomized clinical trial was performed to evaluate the anatomic and functional results of face down position after MH surgery. Eyes were randomized in two groups: P0 and P1. Patients in group P0 were asked to keep a semi–seated position 10 hours per day for five days. Patients in group P1 were asked to keep a face down position 10 hours per day for five days. Macular OCT was performed before and three months after surgery to measure the diameter of macular holes and to asses the postoperative status. A Nonexpanding mixture of air and SF6 was used for pneumatic tamponade in MH less than 500 µm and of air and C2F6 in MH larger than 500 µm. Traumatic MH and MH larger than 800 µm were excluded. Minimum follow up was three months.

Results: : Hundred and four eyes were enrolled. In the P0 group, closure of the MH at one month occurred in 45/50 eyes (90 %). In the P1 group, closure of the MH occurred in 52/54 eyes (96 %). For MH < 500 µm the success rate was 30/32 eyes in group P0 (94%) and 37/38 eyes in group P1 (97%). The difference between groups was not significant. The median of visual acuity increased from 1 to 0.52 logMAR in each group without a statically significant difference between groups (Wilcoxon test).

Conclusions: : The position after macular hole surgery does not seem to have a strong influence on the outcome of the surgery, especially for small size macular holes. Face down position does not improve visual acuity compared to the semi–seated position. However a larger series with a longer follow up is mandatory to confirm these preliminary results.

Keywords: macular holes • retina