Face-down positioning or posturing after macular hole surgery

Abstract

Editorial group: Cochrane Eyes and Vision Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 11, 2023.

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing. 12,13,[26][27][28] To the best of our knowledge, this is the first direct confirmatory evidence supported by clear OCT images obtained from every gas-filled eye. These data further support an individualized postoperative strategy.…”

“…12,26,27 However, a uniform prone posturing protocol would place an unnecessary inconvenience on many patients, therefore it seems reasonable to use the SD-OCT findings to individualize the postoperative posturing. 12,13,[27][28][29] Our results also showed that a smaller MH required a shorter posturing duration after surgery, which would indicate that the traditional posturing duration may not be necessary for small MHs. This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing.…”

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing. 12,13,[26][27][28] To the best of our knowledge, this is the first direct confirmatory evidence supported by clear OCT images obtained from every gas-filled eye. These data further support an individualized postoperative strategy.…”

“…12,26,27 However, a uniform prone posturing protocol would place an unnecessary inconvenience on many patients, therefore it seems reasonable to use the SD-OCT findings to individualize the postoperative posturing. 12,13,[27][28][29] Our results also showed that a smaller MH required a shorter posturing duration after surgery, which would indicate that the traditional posturing duration may not be necessary for small MHs. This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing.…”

Idiopathic macular holes – A review of current management strategies

“…[12] Solebo et al conducted a Cochrane review which included three RCTs investigating the impact of posturing on the outcome of surgery for MHs. [39] These study results showed favorable anatomic results for posturing in large (>400 µm) MHs, while no significant advantage was shown for small ones.…”

Macular hole closure with a vertical joint of the inner limiting membrane (ILM)

“…The formation of this vertical standing ILM has not yet been described, and while the cause is unknown, we can hypothesise that it is likely the result of the free edges of the inverted ILM flap being too long, allowing contact and sealing together. Another factor contributing to forming the vertical ILM joint could be positioning; while in a small MH, posture has no significant effect,12 13 we cannot exclude an effect in this case 14. The last factor could be related to air–fluid interference during air reflux exchange.…”

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing. 12,13,[26][27][28] To the best of our knowledge, this is the first direct confirmatory evidence supported by clear OCT images obtained from every gas-filled eye. These data further support an individualized postoperative strategy.…”

“…12,26,27 However, a uniform prone posturing protocol would place an unnecessary inconvenience on many patients, therefore it seems reasonable to use the SD-OCT findings to individualize the postoperative posturing. 12,13,[27][28][29] Our results also showed that a smaller MH required a shorter posturing duration after surgery, which would indicate that the traditional posturing duration may not be necessary for small MHs. This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing.…”

Idiopathic macular holes – A review of current management strategies

“…[12] Solebo et al conducted a Cochrane review which included three RCTs investigating the impact of posturing on the outcome of surgery for MHs. [39] These study results showed favorable anatomic results for posturing in large (>400 µm) MHs, while no significant advantage was shown for small ones.…”

Macular hole closure with a vertical joint of the inner limiting membrane (ILM)

“…The formation of this vertical standing ILM has not yet been described, and while the cause is unknown, we can hypothesise that it is likely the result of the free edges of the inverted ILM flap being too long, allowing contact and sealing together. Another factor contributing to forming the vertical ILM joint could be positioning; while in a small MH, posture has no significant effect,12 13 we cannot exclude an effect in this case 14. The last factor could be related to air–fluid interference during air reflux exchange.…”

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing. 12,13,[26][27][28] To the best of our knowledge, this is the first direct confirmatory evidence supported by clear OCT images obtained from every gas-filled eye. These data further support an individualized postoperative strategy.…”

“…12,26,27 However, a uniform prone posturing protocol would place an unnecessary inconvenience on many patients, therefore it seems reasonable to use the SD-OCT findings to individualize the postoperative posturing. 12,13,[27][28][29] Our results also showed that a smaller MH required a shorter posturing duration after surgery, which would indicate that the traditional posturing duration may not be necessary for small MHs. This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing.…”

Idiopathic macular holes – A review of current management strategies

“…[12] Solebo et al conducted a Cochrane review which included three RCTs investigating the impact of posturing on the outcome of surgery for MHs. [39] These study results showed favorable anatomic results for posturing in large (>400 µm) MHs, while no significant advantage was shown for small ones.…”

Macular hole closure with a vertical joint of the inner limiting membrane (ILM)

“…The formation of this vertical standing ILM has not yet been described, and while the cause is unknown, we can hypothesise that it is likely the result of the free edges of the inverted ILM flap being too long, allowing contact and sealing together. Another factor contributing to forming the vertical ILM joint could be positioning; while in a small MH, posture has no significant effect,12 13 we cannot exclude an effect in this case 14. The last factor could be related to air–fluid interference during air reflux exchange.…”