Face-down positioning or posturing after macular hole surgery

The Case Mix of Patients Presenting with Full-Thickness Macular Holes and Progression before Surgery: Implications for Optimum Management

“…There is general consensus that ILM peeling improves primary anatomical hole closure rate and is now widely practiced but some surgeons do not peel ILM if hole size is <400 μm because of the potential of iatrogenic harm from the peeling procedure [3,4,13,14]. The need for posturing is debated with many studies showing successful non-posturing surgery in holes <400 μm and often with the use of short-acting gases [5,15,16,17,18]. Large holes are still usually treated with longer-acting gases and posturing [5,6,7,19,20] although the requirement for posturing is debated and a further study is needed [21].…”

“…The need for posturing is debated with many studies showing successful non-posturing surgery in holes <400 μm and often with the use of short-acting gases [5,15,16,17,18]. Large holes are still usually treated with longer-acting gases and posturing [5,6,7,19,20] although the requirement for posturing is debated and a further study is needed [21]. For about 3/4 (72%) of our patients' vitrectomy surgery would currently be the only available treatment option but in only approximately a 1/3 of the cases (28.5%), would vitrectomy, ILM peeling, long-acting gas and post-operative face-down posturing be recommended by the majority of surgeons.…”

“…Inner limiting membrane (ILM) peeling has been shown to be beneficial in terms of closure for all macular holes but because of potential side effects some surgeons do not peel in small and medium-sized holes [3,4]. Two randomized controlled trials have shown that post-operative face-down posturing improves hole closure rate in holes >400 μm in size but many surgeons practice non-posturing surgery in those <400 μm [5,6,7]. The mix of macular hole cases thus presenting to surgeons is important in predicting which options will be selected and which resources needed.…”

Individualized, Spectral Domain-Optical Coherence Tomography–guided Facedown Posturing After Macular Hole Surgery

“…12,26,27 However, a uniform prone posturing protocol would place an unnecessary inconvenience on many patients, therefore it seems reasonable to use the SD-OCT findings to individualize the postoperative posturing. 12,13,[27][28][29] Our results also showed that a smaller MH required a shorter posturing duration after surgery, which would indicate that the traditional posturing duration may not be necessary for small MHs. This is consistent with earlier reports that no posturing or short-term posturing has the same closure rate for small MHs than traditional 7-day posturing.…”

“…12 Despite these improvements, there are still concerns that a shorter duration of posturing might lead to failure in some eyes. 7,13 To maximize the success rate of MH closure, while minimizing the inconvenience on patients, an individualized program would be preferable to a uniform protocol, that is, a pro re nata (PRN) approach.…”