Clinical Study
Eye (2007) 21, 802–806; doi:10.1038/sj.eye.6702339; published online 31 March 2006
Macular hole surgery without prone positioning
The authors state that they have no proprietary interests
This work has been presented as a poster at the Association for Research in Vision & Ophthalmology, Fort Lauderdale, USA, May 2005
P G Tranos1,3, N M Peter2,3, R Nath2,3, M Singh2, S Dimitrakos1, D Charteris1 and C Kon2
- 1Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, UK
- 2Department of Ophthalmology, Worthing General Hospital, Worthing, UK
Correspondence: NM Peter, Western Eye Hospital, Marylebone Rd, London, NW1 SYE, UK. Tel: +44 7973 679733; Fax: +44 1753 740674; E-mail: neenapeter@yahoo.co.uk
3Joint first authors
Received 21 October 2005; Accepted 15 February 2006; Published online 31 March 2006.
Abstract
Purpose
To investigate the role of vitrectomy without prone posturing in the anatomic and functional outcome of macular hole surgery (MHS).
Methods
Forty-one consecutive eyes of 41 patients with stage II–IV full-thickness macular holes underwent pars plana vitrectomy and 16% C3F8 tamponade. In 25 cases posturing group (P), subjects were instructed to assume prone positioning for 10 days postoperatively, whereas in 16 cases non-posturing group (NP) patients were advised to avoid lying supine but no other posturing instructions were given. Preoperative, intraoperative and postoperative clinical data were collected, with macular hole closure rate and change in LogMAR visual acuity, contrast sensitivity, metamorphopsia, and 25-Visual Function Questionnaire (VFQ-25) being the primary outcome measures.
Results
Over a mean follow-up of 4.2
1.2 months, anatomical hole closure was noted in 22/25 (88%) and 14/16 (87.5%) in groups P and NP respectively. Visual acuity improved by a mean of eight letters and there was no significant difference in the two groups (P=0.724). Similarly, postoperative prone posturing did not have an effect on the final contrast sensitivity, metamorphopsia, and VFQ-25 composite scores (P=0.238, P=0.472, and P=0.87, respectively). However, eyes in group NP developed significantly more severe cataract in the early postoperative period (P=0.02).
Conclusions
Prone posturing following MHS provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for all phakic patients undergoing MHS.
Keywords:
macular hole, prone posturing
