Original article
Comparison of Face-Down and Seated Position After Idiopathic Macular Hole Surgery: A Randomized Clinical Trial

https://doi.org/10.1016/j.ajo.2008.02.029Get rights and content

Purpose

To compare two therapeutic modalities on anatomic and functional results after idiopathic macular hole (MH) surgery: seated vs face-down position.

Design

Multicenter, prospective, randomized trial.

Methods

setting: University Hospital Dijon and University Hospital Nancy. patients: One hundred and forty-four patients (150 eyes) were enrolled and randomly separated into two groups for postoperative position: for the 72 eyes in the P0 group and the 78 eyes in the P1 group, the patients were asked to keep the seated (P0 group) and the face-down position (P1 group) after the idiopathic MH surgery. intervention: All patients underwent a complete vitrectomy with a fluid-air exchange and an intraocular gas tamponade. After the surgery, patients were asked to keep one of the two randomly chosen positions for five days. main outcome measures: Best-corrected visual acuity (VA), fundus examination, and macular optical coherence tomography were performed before and six months after surgery.

Results

The overall anatomic success rate was 92.7%. The idiopathic MH sealed in 63 of 72 P0 eyes (87.5%) and 76 of 78 P1 eyes (97.4%) (P = .027). The mean VA increased from 0.86 to 0.61 logMAR (0.88 to 0.61 in P0 and 0.84 to 0.60 in P1). However, in a post hoc analysis based on the size of the idiopathic MH, the success rate in idiopathic MHs smaller than 400 μm was not influenced by the postoperative position (P = .47).

Conclusions

A face-down postoperative position is highly recommended in holes larger than 400 μm. The size of the idiopathic MH seems to be an important factor affecting outcome.

Section snippets

Methods

A prospective, interventional, comparative and randomized clinical trial was conducted in 150 eyes of 144 consecutive patients undergoing MH surgery in two academic centers between July 1, 2004 and January 31, 2006. Patients had complete information about the study and the risks of the surgical procedure, especially retinal detachment (RD), and gave their written consent before surgery.

Patients with stage 2, 3, and 4 idiopathic MHs according to Gass1 and confirmed by optical coherence

Results

One hundred and fifty eyes were included in this prospective series; patient characteristics are given in Table 1. The intraocular gases used are given in Table 2. The minimum follow-up was six months (mean, 15 months; range, six to 25). Overall, 92.7% of the MHs were closed with one operation (139 anatomic successes out of 150 idiopathic MH surgeries). For the P0 group, the anatomic success rate was 87.5% (63/72) vs 97.4% (76/78) for the P1 group. The difference between P0 and P1 was

Discussion

Proper idiopathic MH management requires that the edges of the hole be kept dry with the gas tamponade and the closure of the hole be achieved within a few days.

Intraocular gas tamponade has two main properties: surface tension and buoyancy.22, 25 Buoyancy is related to density and surface tension is related to the viscosity of the tamponade product. The surface tension is constant around the entire interface with the retina. The buoyant force is maximal at the apex of the bubble depending on

References (35)

  • J.T. Thompson et al.

    Intraocular tamponade duration and success of macular hole surgery

    Retina

    (1996)
  • M. Yoshida et al.

    Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling

    Retina

    (2007)
  • B.M. Glaser et al.

    Transforming growth factor-beta 2 for the treatment of full-thickness macular holesA prospective randomized study

    Ophthalmology

    (1992)
  • W.E. Smiddy et al.

    Transforming growth factor-beta 2 significantly enhances the ability to flatten the rim of subretinal fluid surrounding macular holesPreliminary anatomic results of a multicenter prospective randomized study

    Retina

    (1993)
  • A. Gaudric et al.

    Use of autologous platelet concentrate in macular hole surgery: report of 77 cases

    Dev Ophthalmol

    (1997)
  • E. Ezra et al.

    Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing natural history, vitrectomy, and vitrectomy plus autologous serum: Morfields Macular Hole Study Group Report No. 1

    Arch Ophthalmol

    (2004)
  • H.F. Fine et al.

    Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease

    Ophthalmology

    (2007)
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