Single night postoperative prone posturing in idiopathic macular hole surgery

Area of Science:

• Ophthalmology
• Surgical Innovation
• Retinal Surgery

Background:

• Idiopathic macular holes are a significant cause of vision loss.
• Trans pars plana vitrectomy (TPPV) with internal limiting membrane (ILM) peeling is a standard treatment.
• The role of postoperative positioning in enhancing outcomes remains an area of investigation.

Purpose of the Study:

• To evaluate the efficacy of a single night of postoperative prone (face-down) posturing.
• To assess the impact of this regimen on the anatomical closure of idiopathic macular holes.
• To determine the effect on visual acuity and compare outcomes with and without concurrent cataract surgery.

Main Methods:

• A prospective trial involving 14 patients with idiopathic macular holes.
• All patients underwent TPPV with ILM peeling and 20% perfluoroethane (C2F6) gas tamponade.
• Postoperative management included one night of prone positioning, followed by standard care. Visual acuity and OCT scans were used for assessment.

Main Results:

• 100% of macular holes achieved anatomical closure at 3 and 6 months postoperatively.
• Mean visual acuity improved significantly, reaching 0.61 logMAR at 3 months and remaining stable.
• Concurrent cataract extraction (in 50% of cases) did not negatively impact closure rates or visual outcomes.

Conclusions:

• A brief, one-night prone posturing regimen is effective for idiopathic macular hole closure following TPPV with ILM peel and C2F6 gas.
• This approach offers a reasonable strategy for achieving successful anatomical and visual recovery.
• The combination of vitrectomy, ILM peeling, C2F6 gas, and short-term prone positioning is safe and effective.