Nonsupine positioning after macular hole surgery: A prospective multicenter study

Abstract

Purpose: To evaluate the postoperative closure rate of full-thickness macular holes (MHs) after nonsupine positioning, which means that the patients avoid upward gaze and a supine sleeping position, and to investigate the correlation between postoperative positioning compliance and closure rate. Design: Prospective, multicenter study (ClinicalTrials.gov identifier, NCT02295943). Participants: Patients undergoing primary surgery for primary MH. Methods: Patients underwent pars plana vitrectomy with internal limiting membrane peeling and sulfur hexafluoride gas tamponade followed by 3 to 5 days of nonsupine positioning. A positioning measuring device that recorded the time spent in the supine position was attached to patients’ forehead after surgery for 24 hours. Main Outcome Measures: Anatomic closure rate of MH at 2 weeks or more after surgery and the time spent in supine position during the first 24 hours after surgery. Results: A total of 205 participants were included, of whom 2 were lost to follow-up. Two hundred two of 203 MHs closed after a single operation, giving a closure rate of 99.5% (95% confidence interval, 97.3%–99.9%). The median time of supine positioning during the first 24 hours was 28 seconds (range, 0:00:00–01:52:28). Because of the very high closure rate, a correlation between positioning compliance and closure rate could not be established. Conclusions: Pars plana vitrectomy with internal limiting membrane peeling followed by a short-term nonsupine positioning accomplished a very high MH closure rate. Thus, face-down positioning was not necessary to achieve excellent closure rates in this study.