title: Face-down or no face-down posturing following macular hole surgery: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the impact of postoperative posturing with or without face-down on the anatomical and functional outcomes of macular hole surgery.
  
  
  METHODS
  A literature-based meta-analysis was conducted to identify studies relevant to posturing following macular hole surgery (MHS). PubMed and Web of Science databases were used to retrieve articles up to 1 June 2015. The primary measures included MH closure and ideal vision acuity improvement. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated in Review Manager.
  
  
  RESULTS
  Four randomized control trials (RCTs) comprising 251 cases were included in the final meta-analysis. No face-down posturing (FDP) after MHS revealed lower anatomic success rate compared to face-down posturing (OR = 0.33, 95% CI [0.13, 0.81], p = 0.02). For holes smaller than 400 μm in size, the subgroup meta-analysis indicated no significant effect of FDP on successful hole closure (OR = 0.29, 95% CI [0.01, 7.34], p = 0.45). However, when holes were larger than 400 μm, it seemed less effective on MH closure following surgery in no FDP group (OR = 0.23, 95% CI [0.07, 0.71]), and this was statistically significant (p = 0.01).
  
  
  CONCLUSIONS
  Our work found that no FDP was not inferior to its face-down counterpart for the success of MHS when macular holes were smaller than 400 μm in size. For macular holes larger than 400 μm, statistical analysis proved that FDP might be necessary. More well-conducted randomized control trials are needed to verify our findings.
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Zizhong
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Xie
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Yuzhi
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Dongqing
authors.initials: D
authors.lastname: Yuan
authors.affiliation: Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Qinghuai
authors.initials: Q
authors.lastname: Liu
mesh_terms: D058450:Endotamponade; D005466:Fluorocarbons; D006801:Humans; D016684:Prone Position; D012167:Retinal Perforations / Q000473:pathology / Q000601:surgery*; D014821:Vitrectomy
chemical_list: D005466:Fluorocarbons; C042852:perflutren
keywords: face down; macular hole; meta-analysis; posturing