Does Positioning Facedown Following Surgery Improve Closure in Large Macular Holes?

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In this randomized, parallel group superiority trial, 185 participants with an idiopathic full-thickness macular hole of at least 400 μm minimum linear diameter for < 12 months underwent vitrectomy surgery with peeling of the internal limiting membrane and injection of perfluoropropane (14%) gas, with or without simultaneous surgery for cataract.

For 8 hours daily over the course of 5 days following surgery, patients were randomly assigned to position facedown or faceup.

In 85.6% who were advised to position face forward and 95.5% of patients advised to position facedown macular hole closure was observed. At 3 months, mean improvement in best-corrected visual acuity was 0.34 in the face-forward group and 0.57 in the facedown group. The median National Eye Institute Visual Function Questionnaire 25 score was 89 and 87 in the facedown and face-forward group, respectively.

The authors concluded that, “The results do not prove that facedown positioning following surgery is more likely to close large macular holes compared with facing forward but do support the possibility that visual acuity outcomes may be superior.”


Saruban Pasu S; Bell L; Zenasni Z et al. Facedown positioning following surgery for large full-thickness macular hole: A multicenter randomized clinical trial. JAMA Ophthalmol. 2020;doi:10.1001/jamaophthalmol.2020.0987

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