Macular Hole Surgery Without Prone Positioning

Abstract

Abstract: : Purpose: To investigate the role of vitrectomy without prone posturing in the anatomic and functional outcome of macular hole surgery Design: Prospective, non randomised, controlled study. Methods: Forty one consecutive eyes of 40 patients with stage II–IV full thickness macular holes underwent pars plana vitrectomy and 16% C3F8 tamponade. In twenty five cases (group I), subjects were instructed to assume prone positioning for 10 days postoperatively whereas in 16 cases (group II) patients were advised to avoid lying supine but no other posturing instructions were given. Preoperative, intraoperative and postoperative clinical data were collected with macular hole closure rate and change in LogMAR visual acuity, contrast sensitivity and metamorphopsia being the primary outcome measures. Results: Over a mean follow up of 4.2 ± 1.2 months anatomical hole closure was noted in 22/25 (88%) and 14/16 (87.5%) in groups I and II respectively. Visual acuity improved by a mean of 8 letters and there was no significant difference in the 2 groups (p=0.724). Similarly, postoperative prone posturing did not have an effect on the final contrast sensitivity and metamorphopsia (p=0.238 and p=0.472 respectively). However, eyes in group II developed significantly more severe cataract in the early postoperative period (p=0.02). Conclusions: Prone posturing following macular hole surgery provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for all phakic patients undergoing macular hole surgery.

Keywords: macular holes • clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: systems/equipment/techniques