Evaluation of posturing in macular hole surgery

Abstract

Aim To objectively evaluate the postoperative face down posturing in macular hole surgery. Materials and Methods An electronic device called 'Maculog' was developed consisting of three basic components, a mercury switch triggered by the angle of tilt placed inside an earpiece, a data-recording device connected to the earpiece with cables and a windows based software program, specially written to analyse the recorded data in the form of tables and graphs. Ten patients undergoing macular hole surgery were fitted with the device on the first postoperative day before discharge. They were also asked for a subjective record of their posturing times. Four patients were given a posturing chair to take home. The device was retrieved after the first week and the data were downloaded to a PC for analysis. The actual posturing times recorded on the device were compared to the patients' own recollections. Results In all ten patients the actual posturing time was less than the time they had recorded themselves. The average actual posturing time was 48% of the perceived posturing time. The worst time for posturing, as expected, was between midnight and early morning. The compliance was better in patients who used the posturing chair. Conclusions It is feasible to quantify the time of posturing using an electronic device and computer analysis. The study has shown that the actual posturing time is significantly less than the perceived posturing time. A further large study using 'Maculog' is now planned to correlate actual posturing time to the results of macular hole surgery.

25-Gauge Vitrectomy Using Sulfur Hexafluoride and No Prone Positioning for Repair of Macular Holes

“…24 Series comparing 1-week prone positioning with 3-day, 14 1-day, 13 or no prone positioning failed to disclose any significant differences in closure rates after single surgery. 17,21 Furthermore, a single case report in which gas fill was 20% on the first postoperative day due to inadvertent escape of gas and daily optical coherence tomography was performed showed closure of a stage 2 macular hole on the first operative day with establishment of normal foveal contour on the second postoperative day (the patient received a 0.4-mL injection of 100% SF 6 on the first postoperative day).…”

Functional outcome and patient preferences following combined phaco-vitrectomy for macular hole without prone posturing

“…A study designed to objectively evaluate the time of post-operative posturing by patients undergoing macular hole surgery questioned the importance of posturing in determining the success of macular hole surgery. 11 Face down posturing is inconvenient, difficult, and unpopular, especially in the elderly. There have been reports of ulnar nerve palsies attributed to prolonged posturing.…”

Combined 23-gauge, sutureless transconjunctival vitrectomy with phacoemulsification without face down posturing for the repair of idiopathic macular holes

“…The difficulty in adopting such a posture was highlighted by Verma et al, 9 who uncovered that such positioning was only maintained in an average of 38% of patients in their study group without adversely affecting visual and anatomical outcomes. More importantly, prone posturing itself is not without its complications.…”