Face-down positioning versus non-supine positioning in macular hole surgery

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Outcomes

Background:

• Full thickness macular hole (FTMH) repair often involves specific postoperative positioning protocols.
• Face-down positioning (FDP) has been a traditional method, but non-supine positioning (NSP) offers potential patient comfort advantages.

Purpose of the Study:

• To compare the anatomical success rates of FTMH closure between patients utilizing FDP and NSP postoperatively.
• To evaluate the impact of different positioning methods on visual acuity outcomes.

Main Methods:

• Retrospective review of two case series of pseudophakic patients undergoing pars plana vitrectomy for FTMH.
• Internal limiting membrane peeling and perfluoropropane gas tamponade were consistent treatments.
• FTMH closure assessed by optical coherence tomography; visual acuity measured using ETDRS charts at 6 months.

Main Results:

• A total of 122 eyes were analyzed (66 FDP, 56 NSP).
• FTMH closure rates were high and similar in both groups: 95.5% for FDP and 96.4% for NSP.
• Median visual acuity at 6 months was identical (69 ETDRS letters) for both positioning groups.

Conclusions:

• Non-supine positioning achieves similar anatomical success rates to face-down positioning for FTMH repair.
• The necessity of strict FDP for FTMH repair may be reconsidered.
• Future studies should objectively monitor patient positioning compliance.