Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial.
OBJECTIVE
To compare two therapeutic modalities on anatomic and functional results after idiopathic macular hole (MH) surgery: seated vs face-down position.


METHODS
Multicenter, prospective, randomized trial.


METHODS



METHODS
University Hospital Dijon and University Hospital Nancy.


METHODS
One hundred and forty-four patients (150 eyes) were enrolled and randomly separated into two groups for postoperative position: for the 72 eyes in the P0 group and the 78 eyes in the P1 group, the patients were asked to keep the seated (P0 group) and the face-down position (P1 group) after the idiopathic MH surgery.


METHODS
All patients underwent a complete vitrectomy with a fluid-air exchange and an intraocular gas tamponade. After the surgery, patients were asked to keep one of the two randomly chosen positions for five days.


METHODS
Best-corrected visual acuity (VA), fundus examination, and macular optical coherence tomography were performed before and six months after surgery.


RESULTS
The overall anatomic success rate was 92.7%. The idiopathic MH sealed in 63 of 72 P0 eyes (87.5%) and 76 of 78 P1 eyes (97.4%) (P = .027). The mean VA increased from 0.86 to 0.61 logMAR (0.88 to 0.61 in P0 and 0.84 to 0.60 in P1). However, in a post hoc analysis based on the size of the idiopathic MH, the success rate in idiopathic MHs smaller than 400 microm was not influenced by the postoperative position (P = .47).


CONCLUSIONS
A face-down postoperative position is highly recommended in holes larger than 400 microm. The size of the idiopathic MH seems to be an important factor affecting outcome.
Guillaubey
Alexandre
A
Department of Ophthalmology, University Hospital Dijon, Rue du Faubourg Raines, Dijon, France.
Malvitte
Laure
L
Lafontaine
Pierre Olivier
PO
Jay
Nicolas
N
Hubert
Isabelle
I
Bron
Alain
A
Berrod
Jean Paul
JP
Creuzot-Garcher
Catherine
C
D000368:Aged; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000379:methods; D016684:Prone Position; D011446:Prospective Studies; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D005466:Fluorocarbons; C048381:perfluoroethane; C042852:perflutren; D013459:Sulfur Hexafluoride