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    This is the first randomized, controlled trial to show the noninferiority of nonsupine positioning in patients with full-thickness macular holes of all sizes. 

    While previous studies have shown a significantly lower success rate for nonsupine positioning (NSP) in larger full-thickness macular holes (FTMHs), this study showed no statistical difference between NSP and face-down positioning (FDP) in patients with macular holes measuring 400 µm and larger. However, this study did not include FTMHs greater than 800 µm, likely due to the exclusion of chronic FTMHs with symptom duration greater than 2 years.

    Additionally, improvement in visual acuity was similar between regimens, with more than 75% of participants in both groups gaining 15-letters or more.

    For this study, investigators randomized 81 pseudophakic patients to either NSP or FDP following full-thickness macular hole surgery. All subjects underwent pars plana vitrectomy, internal limiting membrane peeling and perfluoropropane gas tamponade. The closure rate was similar between the groups at 97.1%.

    Interestingly, the authors found that the degree of gas fill does affect the closure rate, suggesting that gas fill above 65% on postop day 4 may reduce the risk of poor gas–macula contact and surgical failure. Future studies of positioning in macular hole treatment would benefit from measuring the degree of postoperative gas fill.

    Based on their findings, the authors propose NSP as standard of care in most cases of full-thickness macular holes.