Nonsupine Positioning in Macular Hole Surgery

Alberti, Mark; Cour, Morten la

doi:10.1097/iae.0000000000001041

Cited by 44 publications

(24 citation statements)

References 25 publications

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“…Poor adherence could be attributed to the inconvenience of FDP; therefore, alleviated positioning,6–13,15,19,20,22–25,27,28 which may be easier to comply with, may improve patient adherence and postoperative outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…In the treatment of MH, the optimal manner and the duration of the FDP to optimize patient recovery have been argued 2–28. Although each protocol assumes that the patients will follow the given advice, some patients (approximately 10%) do not comply.…”

Section: Discussionmentioning

confidence: 99%

“…Face-down positioning (FDP) is a standard posture recommended for patients following vitrectomy and gas tamponade procedures during macular hole (MH) surgery 1–28. Patients find the FDP inconvenient, and so it is not readily tolerated; therefore, the optimal method and duration of the FDP have been debated for many years 2–28.…”

Section: Introductionmentioning

confidence: 99%

“…Patients find the FDP inconvenient, and so it is not readily tolerated; therefore, the optimal method and duration of the FDP have been debated for many years 2–28. Shortening the duration of the FDP2,5,8,10,11,14,16,17,22 and adopting alleviated positioning, such as avoidance of the supine or face-up positioning by the patients,6–13,15,19,20,22–25,27,28 have been proposed and statistically compared with strict FDP 5,7–12,21–25,27,28. However, these studies lacked adherence controls, and the intervention was the advice given to the patients to maintain the positioning rather than the positioning itself 21.…”

Section: Introductionmentioning

confidence: 99%

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Patient adherence to the face-down positioning after macular hole surgery

Shimada¹,

Seno²,

Mizuguchi³

et al. 2017

OPTH

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PurposeTo determine adherence to face-down positioning (FDP) among patients who underwent vitrectomy and gas tamponade for macular hole (MH) repair.MethodA total of 69 patients (37 females and 32 males) who underwent primary vitrectomy for MH repair were studied. Nurses recorded whether the patient complied with FDP each time they examined the patient. FDP score was obtained from the nursing records; patients were given a score of 1 if they complied with the FDP and 0 if they did not. The score was recorded four times per day for the first 3 postoperative days. A perfect FDP score was 12.ResultsThe mean ± standard deviation of the FDP scores was 10.6±1.8 (range: 4–12). Overall, 32 (46.4%) patients scored a perfect 12, and 7 (10.1%) patients scored <8. Failure of the MH closure was observed in only one patient (1.4%), who showed the poorest adherence to FDP (score =4). Consequently, the closure rate in patients with FDP score <7 (2/3, 66.7%) was significantly lower than in patients with an FDP score ≥7 (66/66, 100%) (P<0.05, Fisher’s exact probability test).ConclusionWhile adherence to FDP after MH surgery was better than that observed after vitrectomy for rhegmatogenous retinal detachments in our previous study, the percentage of patients with FDP scores <8 did not differ. Statistically, the poor adherence to FDP can negatively impact the effectiveness of the surgery for MH repair.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient adherence to the face-down positioning after macular hole surgery

Shimada¹,

Seno²,

Mizuguchi³

et al. 2017

OPTH

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“…Of these 34 reports, 8 were not RCTs, 2 did not apply ILM peeling, and 19 did not included a comparison group, so they were excluded from the meta-analysis owing to conflict with the inclusion criteria. The remaining 5 RCTs were included in the final meta-analysis [14,[18][19][20][21]. The trial selection process is summarized in Fig.…”

Section: Search Results and Characteristics Of The Studiesmentioning

confidence: 99%

Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

Liao

Liu

et al. 2019

Preprint

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Background After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following macular hole surgery. Methods Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. Results Five RCTs were included in this meta-analysis. These contained a total of 183 eyes in the FDP group and 175 in the nFDP group. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH size smaller than 400 µm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 µm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). Conclusions Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 µm. For MHs larger than 400 µm, meta-analysis results demonstrated that an FDP might be highly recommended. Further RCTs with large numbers of samples are warranted to validate these findings in the future.

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