title: Face-down posturing after macular hole surgery: a meta-analysis.
abstract: AIMS To assess the effect that the duration of face-down posturing has on the outcome of macular hole surgery. METHODS A literature search was conducted to identify studies related to posturing duration following macular hole surgery. Where appropriate, studies were compared in a meta-analysis. The Mantel-Haenszel fixed-effect method was used to calculate the summary statistics. The main outcome measures were macular hole closure rate and visual acuity improvement. RESULTS 17 studies investigating the effect of face-down posturing time on the outcome of macular hole surgery were identified. 9 studies included a comparison group and were deemed suitable for inclusion in the meta-analysis. Studies were divided into two groups depending on the duration of face-down posturing investigated. The meta-analysis revealed an RR of anatomical failure of 1.34 (95% CI 0.66 to 2.72) with face-down posturing for 24 h or less compared with face-down posturing for 5-10 days, but this was not statistically significant (p=0.42). The study design was too dissimilar to allow a meaningful comparison of visual acuity outcomes. CONCLUSIONS Currently there is insufficient evidence to allow firm conclusions as to whether face-down posturing following macular hole surgery influences hole closure rates. Meta-analyses are limited by the quality of included studies; a well-conducted randomised control trial is needed.
authors.affiliation: Department of Ophthalmology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. andrewtatham@yahoo.co.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Tatham
authors.forename: Somnath
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D015982:Bias; D006801:Humans; D056888:Patient Positioning / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D016684:Prone Position; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity