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Study recommends face-down positioning postop for large macular hole closure

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Postoperative positioning appears to influence the rate of macular hole closure, according to a prospective study by researchers in France. Specifically, the study authors recommended a face-down postoperative position for holes larger than 400 µm.

"However, the good prognosis and the quick closure of idiopathic [macular holes] smaller than 400 µm probably make the face-down position unnecessary in selected patients," they said. "Further prospective studies considering not only the positioning but also the size of the [macular holes] are warranted to confirm these results."

Catherine Creuzot-Garcher, MD, PhD, and colleagues at University Hospital Dijon and University Hospital Nancy performed complete vitrectomy with a fluid-air exchange and intraocular gas tamponade on 150 eyes of 144 patients with idiopathic macular holes. After surgery, patients were randomly assigned either to remain seated or to assume a face-down position for 8 hours daily for a duration of 5 days. Specifically, 72 eyes were assigned to the seated position group and 78 eyes were assigned to the face-down group.

Best corrected visual acuity, fundus examination and macular optical coherence tomography were performed at baseline and at 6 postoperative months; follow-up averaged 15 months, ranging from 6 to 25 months.

The anatomic success rate for the entire cohort was 92.7%, the authors noted.

The idiopathic macular holes sealed in 63 of 72 eyes (87.5%) in the seated position group and in 76 of 78 eyes (97.4%) in the face-down position group (P = .027).

Overall, mean visual acuity increased from 0.86 logMAR to 0.61 logMAR in the seated position group and from 0.84 logMAR to 0.60 logMAR in the face-down position group.

In a post hoc analysis based on the size of the idiopathic macular holes, the investigators found that postoperative position did not significantly influence the success rate in holes smaller than 400 µm, according to the study, published in the July issue of American Journal of Ophthalmology.