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Mark Alberti, Morten D De La Cour; Gas-foveal contact in macular hole surgery - a comparison of face-down and non-supine positioning. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1065. doi: https://doi.org/.
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Controversy exists regarding the optimal postoperative positioning regimen after macular hole repair. Patient positioning affects the gas-foveal contact critical to surgical success. Gas-foveal contact can be estimated by logging the angle of head pitch as well as measuring the postoperative intraocular gas fill. We hypothesized equal postoperative gas-foveal contact with face-down positioning (FDP) and non-supine positioning (NSP).
Participants with a macular hole were randomized to either FDP or NSP. In the FDP-group we prescribed 30 hours of FDP during the first 72 postoperative hours and in the NSP-group we instructed participants to avoid the supine position. Primary outcome was patient positioning logged with an electronic sensor during the first 72 postoperative hours as well as intraocular gas fill measured on postoperative day 4. Gas-foveal contact is calculated by combining the primary outcome measures. Secondary outcome was subjective compliance data obtained from a questionnaire.
Recording of head position was possible in 33/35 FDP participants and 35/37 NSP participants. Daytime median head pitch was -42.9○ in the FDP-group and -10.9○ in NSP-group (p<0.001). Nighttime median head pitch was -5.7○ and -1.9○ in the FDP and NSP-group, respectively (p<0.001). FDP-group median gas fill was 78.3% (range 57.4-85.7) similar to the NSP-group median gas fill of 75.9% (range 56.2-84.8; p=0.48). Median gas-foveal contact was 99.82% (range 73.6-100.0) in the FDP-group and 99.57% (range 85.3-100.0) in the NSP-group (p=0.22) corresponding to a gas-foveal separation time ranging from 0.0 seconds - 19.0 hours in the FDP-group and 2.0 seconds - 10.6 hours in the NSP-group during the first 72 postoperative hours. Overall gas-foveal contact correlated with degree of intraocular gas fill (r2=0.29, p<0.001). Overall gas-foveal separation was less during daytime as compared to nighttime; median daytime separation was 66.5 seconds compared to median nighttime separation of 402.5 seconds (6.7 minutes; p<0.001).
Gas-foveal contact time is marginally greater with FDP compared to NSP, however, the difference is not statistically significant. Degree of intraocular gas seems to markedly influence the gas-foveal contact time highlighing the importance of maximal intraocular gas fill in macular hole surgery.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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