FEB 11, 2011
Retina/Vitreous
Although macular hole surgery has a high success rate, facedown positioning after surgery remains an ordeal for patients and in rare cases can cause complications such as thrombophlebitis and pulmonary embolism or ulnar nerve palsies. Only one randomized series has been published showing a significant reduction of the success rate without facedown positioning. However, a post hoc analysis of this study suggested that this reduction was significant only for macular holes larger than 400 μm. The authors of this prospective study considered only small idiopathic macular holes (diameter ≤400 μm) in its investigation of whether surgery success is significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position.
They randomized 69 patients with small idiopathic macular holes (≤ 400 µm) to strict facedown positioning for 22 of 24 hours after surgery or instruction to avoid the supine position for 10 days. All patients underwent pars plana vitrectomy, peeling of any epiretinal membrane, and 17% C2F6 gas filling. At three months postop, the closure rate was more than 90 percent in both groups, mean gain in visual acuity was similar, and the complication rate was similar.
The authors conclude that suppressing postoperative facedown positioning for patients with small macular holes seems reasonable because it makes surgery far less uncomfortable, avoids certain complications, and speeds up rehabilitation.