Pilot randomised controlled trial of face-down positioning following macular hole surgery |
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Authors: | Lange C A K Membrey L Ahmad N Wickham L Maclaren R E Solebo L Xing W Bunce C Ezra E Charteris D Aylward B Yorston D Gregor Z Zambarakji H Bainbridge J W |
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Institution: | Moorfields Eye Hospital, London, UK. |
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Abstract: | ObjectiveThis was a pilot randomised controlled trial (RCT) to investigate the effect of post-operative face-down positioning on the outcome of macular hole surgery and to inform the design of a larger definitive study.MethodsIn all, 30 phakic eyes of 30 subjects with idiopathic full-thickness macular holes underwent vitrectomy with dye-assisted peeling of the ILM and 14% perfluoropropane gas. Subjects were randomly allocated to posture face down for 10 days (posturing group) or to avoid a face-up position only (non-posturing group). The primary outcome was anatomical hole closure.ResultsMacular holes closed in 14 of 15 eyes (93.3% 95% confidence interval (CI) 68–100%) in the posturing group and in 9 of 15 (60% 95% CI 32–84%) in the non-posturing group. In a subgroup analysis of outcome according to macular hole size, all holes smaller than 400?μm closed regardless of posturing (100%). In contrast, holes larger than 400?μm closed in 10 of 11 eyes (91% 95% CI 58–99%) in the posturing group and in only 4 of 10 eyes (40% 95% CI 12–74%) in the non-posturing group (Fisher''s exact test P=0.02).ConclusionPost-operative face-down positioning may improve the likelihood of macular hole closure, particularly for holes larger than 400?μm. These results support the case for a RCT. |
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Keywords: | macular hole face down positioning prone posturing |
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