Comparison of Face-Down and Seated Position After Idiopathic Macular Hole Surgery: A Randomized Clinical Trial

Guillaubey, A.; Malvitte, L.; Lafontaine, P.O.; Jay, Nicolas; Hubert, I.; Bron, Alain M.; Berrod, J.–P.; Creuzot‐Garcher, Catherine

doi:10.1016/j.ajo.2008.02.029

Cited by 117 publications

(102 citation statements)

References 33 publications

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“…The results of this study are consistent with those of Guillaubey et al 17 in suggesting that post-operative face-down positioning can improve the likelihood of macular hole closure. The possible benefit of face-down positioning appears to be relevant to macular holes of greater than 400 mm in diameter.…”

Section: Discussionsupporting

confidence: 83%

“…In our study, we observed an anatomical closure rate of 93.3% and a mean visual acuity gain of 0.23 logMAR unit in the posturing group, a result that is consistent with previously published data. 17,21 In the non-posturing group, in contrast, we found a MH closure rate of only 60% and a mean visual acuity gain of 0.05 logMAR unit. The non-posturing group may have a worse outcome because of increased risk of cataract.…”

Section: Discussioncontrasting

confidence: 39%

“…Several non-randomised comparative series report high rates of anatomical closure with limited or no face-down positioning at all. [7][8][9][10] In 2008, however, Guillaubey et al 17 reported the results of a RCT that suggested that face-down positioning for 5 days can improve the likelihood of hole closure, particularly closure of large holes. In their study, however, nearly half of the eyes underwent combined phaco-vitrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Pilot randomised controlled trial of face-down positioning following macular hole surgery

Lange

Membrey

Ahmad

et al. 2011

Eye

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Objective This was a pilot randomised controlled trial (RCT) to investigate the effect of post-operative face-down positioning on the outcome of macular hole surgery and to inform the design of a larger definitive study. Methods In all, 30 phakic eyes of 30 subjects with idiopathic full-thickness macular holes underwent vitrectomy with dye-assisted peeling of the ILM and 14% perfluoropropane gas. Subjects were randomly allocated to posture face down for 10 days (posturing group) or to avoid a face-up position only (non-posturing group). The primary outcome was anatomical hole closure. Results Macular holes closed in 14 of 15 eyes (93.3%; 95% confidence interval (CI) 68-100%) in the posturing group and in 9 of 15 (60%; 95% CI 32-84%) in the non-posturing group. In a subgroup analysis of outcome according to macular hole size, all holes smaller than 400 lm closed regardless of posturing (100%). In contrast, holes larger than 400 lm closed in 10 of 11 eyes (91%; 95% CI 58-99%) in the posturing group and in only 4 of 10 eyes (40%; 95% CI 12-74%) in the non-posturing group (Fisher's exact test P ¼ 0.02). Conclusion Post-operative face-down positioning may improve the likelihood of macular hole closure, particularly for holes larger than 400 lm. These results support the case for a RCT.

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Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

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Pilot randomised controlled trial of face-down positioning following macular hole surgery

Lange

Membrey

Ahmad

et al. 2011

Eye

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“…10 For holes > 400 µm, success rate has been found to be significantly higher with face-down posturing than sitting posture after surgery (95.1% versus 79.5%). 15 The low rates of hole closure in our study may be attributed to poor compliance with post-operative head posturing or large hole size.…”

Section: Discussionmentioning

confidence: 52%

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

et al. 2016

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Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

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“…In a large randomised trial of posturing for macular hole, patients who had combined surgery did not have a higher success rate than those who had vitrectomy alone. 16 One argument against combined surgery is that biometry may be less accurate in the presence of macular disease that reduces central vision. 23 In common with some other authors we found a slight myopic overcorrection, which might be explained by an anterior displacement of the capsular bag caused by the gas bubble.…”

Section: Discussionmentioning

confidence: 99%

Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole

Yorston

Siddiqui

Awan

et al. 2011

Eye

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Background To gather information on the effect of postoperative face-down posturing following combined phacoemulsification and vitrectomy for macular hole surgery in order to assist in the design of a larger definitive study. Methods Thirty phakic patients with stage II-IV full-thickness macular hole had combined phacoemulsification and pars plana vitrectomy with internal limiting membrane peel and 14% perfluoropropane (C 3 F 8 ) gas. At the conclusion of surgery, patients were randomised either to face-down posture or to no posture, for 10 days. The primary outcome was macular hole closure. Results The macular hole was successfully closed in 93.8% of the face-down posture group and in all of the no-posture group. Mean visual improvement was 0.63 (SD ¼ 0.21) logMAR units in the face-down group and 0.53 (SD ¼ 0.22) in the no posture patients. Conclusion Following combined phacoemulsification and vitrectomy, postoperative face-down posturing appears to make little difference to the final anatomical or visual outcome. If we assume a success rate of 95% in the posturing arm, and that there is no difference between posturing and non-posturing, then 798 patients would be required to be 90% sure that the 95% confidence interval will exclude a difference of more than 5%.

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Comparison of Face-Down and Seated Position After Idiopathic Macular Hole Surgery: A Randomized Clinical Trial

Abstract: A face-down postoperative position is highly recommended in holes larger than 400 microm. The size of the idiopathic MH seems to be an important factor affecting outcome.

Cited by 117 publications

References 33 publications

Pilot randomised controlled trial of face-down positioning following macular hole surgery

Pilot randomised controlled trial of face-down positioning following macular hole surgery

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole

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