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Face-down positioning or posturing after macular hole surgery.

Olivia Cundy1, Clemens Ak Lange2,3, Catey Bunce4,5

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|November 21, 2023
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Summary
This summary is machine-generated.

Postoperative face-down positioning after macular hole surgery shows little to no effect on hole closure. This low-risk intervention may not significantly improve outcomes for most patients, especially those with smaller holes.

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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.