title: Individualized, spectral domain-optical coherence tomography-guided facedown posturing after macular hole surgery: minimizing treatment burden and maximizing outcome.
abstract: OBJECTIVE
  To evaluate the individualized, optical coherence tomography-guided facedown posturing after macular hole (MH) surgery in minimizing the burden and maximizing outcome.
  
  
  METHODS
  A retrospective comparative study. One hundred and seven consecutive eyes with an MH (<500 μm) received vitrectomy and gas tamponade. After surgery, optical coherence tomography examination was performed from 6 hours to postoperative Day 2. In Group A, with a pro re nata posturing protocol, the duration of facedown posturing was determined from the optical coherence tomography findings. Group A was subdivided as follows: Group A1, facedown posturing required postoperatively and Group A2, no posturing required. When MH closure was confirmed, facedown posturing (if any) was discontinued. If the MH did not close, additional posturing was advised. Group B was the control group, consisted of 42 consecutive eyes with traditional 7 days of posturing.
  
  
  RESULTS
  After a single surgery, Group A had the MH closure rate of 96.2%, 95.8% in Group A1 and 97.1% in Group A2, whereas Group B had the MH closure rate of 95.2%. The average posturing period was 42 hours for Group A, 57 hours for Group A1 and 10 hours for Group A2 (P < 0.001). The MH size was correlated significantly with the closure time (R = 0.47, P = 0.005, Spearman correlation coefficient).
  
  
  CONCLUSIONS
  A pro re nata posturing protocol achieves a high MH closure rate with a significant reduction of posturing time especially for pseudophakic eyes.
authors: *Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; †Department of Ophthalmology, Kyushu University School of Medicine, Fukuoka, Japan; ‡Department of Ophthalmology, Beppu Medical Center, Oita, Japan; and §Retinal Consultants of Arizona and Spectra Eye Institute, Phoenix, Arizona.
authors: Toshifumi
authors: T
authors: Yamashita
authors: Taiji
authors: T
authors: Sakamoto
authors: Takehiro
authors: T
authors: Yamashita
authors: Shozo
authors: S
authors: Sonoda
authors: Keita
authors: K
authors: Yamakiri
authors: Hiroki
authors: H
authors: Otsuka
authors: Toshio
authors: T
authors: Hisatomi
authors: Hiroyuki
authors: H
authors: Imaki
authors: Tatsuro
authors: T
authors: Ishibashi
authors: Pravin U
authors: PU
authors: Dugel
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D058450:Endotamponade; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016684:Prone Position; D012167:Retinal Perforations / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D013459:Sulfur Hexafluoride