title: Pilot randomised controlled trial of face-down positioning following macular hole surgery.
abstract: OBJECTIVE
  This 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Macular 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).
  
  
  CONCLUSIONS
  Post-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.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: C A K
authors.initials: CA
authors.lastname: Lange
authors.forename: L
authors.initials: L
authors.lastname: Membrey
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
authors.forename: L
authors.initials: L
authors.lastname: Wickham
authors.forename: R E
authors.initials: RE
authors.lastname: Maclaren
authors.forename: L
authors.initials: L
authors.lastname: Solebo
authors.forename: W
authors.initials: W
authors.lastname: Xing
authors.forename: C
authors.initials: C
authors.lastname: Bunce
authors.forename: E
authors.initials: E
authors.lastname: Ezra
authors.forename: D
authors.initials: D
authors.lastname: Charteris
authors.forename: B
authors.initials: B
authors.lastname: Aylward
authors.forename: D
authors.initials: D
authors.lastname: Yorston
authors.forename: Z
authors.initials: Z
authors.lastname: Gregor
authors.forename: H
authors.initials: H
authors.lastname: Zambarakji
authors.forename: J W
authors.initials: JW
authors.lastname: Bainbridge
mesh_terms: D000368:Aged; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D016684:Prone Position; D012167:Retinal Perforations / Q000601:surgery*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D005466:Fluorocarbons