Face-down or no face-down posturing following macular hole surgery: a meta-analysis
Zizhong Hu1, Ping Xie1, Yuzhi Ding1
1Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Acta Ophthalmologica
|September 20, 2015
Summary
Face-down posturing after macular hole surgery is not inferior for smaller holes. However, for larger macular holes, face-down posturing may be necessary for successful surgical outcomes.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Retinal Surgery
Background:
- Macular hole surgery (MHS) outcomes can be influenced by postoperative positioning.
- The necessity and efficacy of face-down posturing (FDP) after MHS remain debated.
Purpose of the Study:
- To evaluate the impact of postoperative posturing, with or without face-down positioning, on anatomical and functional outcomes of macular hole surgery.
Main Methods:
- A literature-based meta-analysis of four randomized control trials (RCTs) involving 251 cases.
- Studies were identified through PubMed and Web of Science searches up to June 2015.
- Primary outcomes were macular hole (MH) closure and visual acuity improvement, analyzed using pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- No face-down posturing (FDP) showed a lower anatomic success rate compared to FDP (OR = 0.33, p = 0.02).
- For macular holes smaller than 400 μm, FDP had no significant effect on hole closure (OR = 0.29, p = 0.45).
- For macular holes larger than 400 μm, no FDP was less effective for MH closure (OR = 0.23, p = 0.01).
Conclusions:
- No FDP is not inferior to FDP for MHS success in smaller macular holes (<400 μm).
- FDP may be necessary for successful MHS in larger macular holes (>400 μm).
- Further well-conducted RCTs are needed to validate these findings.
