Face-down positioning or posturing after macular hole surgery

Area of Science:

• Ophthalmology
• Surgical Outcomes
• Retinal Surgery

Background:

• Macular holes cause significant vision impairment, particularly larger ones (>400 μm).
• Surgical outcomes for macular holes can be improved with specific postoperative protocols.
• This review updates previous Cochrane findings on face-down positioning published in 2011.

Purpose of the Study:

• To evaluate the impact of postoperative face-down positioning on macular hole surgery outcomes.
• To assess the effect on anatomical hole closure, visual acuity, quality of life, and adverse events.

Main Methods:

• Included eight randomized controlled trials (RCTs) comparing face-down positioning to no face-down positioning.
• Searched multiple databases (CENTRAL, MEDLINE, Embase, etc.) up to May 2022.
• Analyzed dichotomous data (risk ratios) and continuous data (mean differences) with 95% confidence intervals.

Main Results:

• Low-certainty evidence suggests face-down positioning has little to no effect on macular hole closure (RR 1.05, 95% CI 0.99 to 1.12).
• No significant difference in hole closure was observed for larger (>400 μm) or smaller (<400 μm) macular holes.
• Face-down positioning is low-risk, with serious adverse events (nerve compression) affecting <1% of participants.

Conclusions:

• Postoperative face-down positioning likely has minimal to no impact on macular hole closure.
• The intervention is associated with discomfort and does not significantly improve visual acuity or quality of life.
• Future trials should focus on larger macular holes with standardized interventions and validated outcome measures.