Uniform facedown posturing unnecessary after macular hole surgery

By Nikki Withers, medwireNews Reporter

An individualised posturing programme after macular hole (MH) surgery can significantly reduce the duration of facedown posturing without compromising outcomes, suggests research published in Retina.

Current MH surgery consists of pars plana vitrectomy with the removal of all traction around the MH, gas tamponade and posturing, say Taiji Sakamoto (Kagoshima University Graduate School of Medical and Dental Sciences, Japan) and colleagues. This results in a closure rate of approximately 90%. However, to maximise the success rate of MH closure while minimising the inconvenience to patients, the team suggests an individualised programme could be preferable to a uniform protocol.

To address this hypothesis, the researchers compared MH closure rates after vitrectomy with pro re nata (PRN) facedown posturing, which was determined from spectral domain optical coherence tomography (SD-OCT) findings, with conventional 7 days of prone positioning.

Regular SD-OCT examinations were performed from 6 hours after surgery to postoperative day 2.

Patients were divided into two groups: group A (107 eyes) with PRN posturing and group B (42 eyes) with the conventional 7 days of prone positioning (control). Group A was further subdivided into group A1, who required facedown posturing postoperatively and group A2, who did not require posturing. Facedown posturing, if any, was discontinued when MH closure was confirmed. However, if the MH did not close, additional posturing, or initiation of posturing in the case of group A2, was advised.

Yamashita et al found that after a single surgery, group A had an overall MH closure rate of 96.2%; with rates of 95.8% and 97.1% for groups A1 and A2, respectively. These rates were similar to the 95.2% MH closure rate seen for group B.

In the subgroup analysis, the average posturing period was shortest in group A2, at a significant 10 hours versus 42 hours for group A, 57 hours for group A1 and the uniform 144 hours (7 days) for group B.

The authors note that the MH size significantly correlated with the closure time.

“These results suggest that individualized facedown posturing by the SD-OCT images can significantly decrease the duration of facedown posturing without compromising the results”, writes Sakamoto and team.

“This suggests that immediate posturing after surgery is not required, and posturing may be imposed when needed as determined by the SD-OCT images”, they add.

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