Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning

Retina. 2012 Mar;32(3):506-10. doi: 10.1097/IAE.0b013e3182219abd.


Purpose: The role of face-down posturing after macular hole (MH) surgery remains unclear and controversial. We evaluated the anatomical and visual outcomes of MH repair using a short duration (3 days) of prone positioning.

Methods: Prospective series of 50 consecutive eyes in 50 patients with Stage 2 or Stage 3 idiopathic MHs. All eyes underwent vitrectomy MH surgery with internal limiting membrane peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, MH closure rates, complications, and postoperative visual acuity were investigated.

Results: Anatomical closure of MHs was achieved in 49 (98%) of 50 eyes by 1 surgery. Postoperative logarithm of the minimum angle of resolution visual acuity decreased (i.e., improved) by 0.271 (95% confidence interval, 0.101-0.441 [P = 0.0024]). One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure fluctuations.

Conclusion: Vitrectomy with internal limiting membrane peeling and gas tamponade with SF6 followed by short-duration 3-day face-down positioning is a successful surgical intervention for Stage 2 and Stage 3 idiopathic MHs. This method possessed minimal complications and offered significant improvement in visual acuity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Canada
  • Cataract Extraction
  • Face
  • Female
  • Humans
  • Intraocular Pressure / physiology
  • Male
  • Middle Aged
  • Postoperative Care / methods
  • Postoperative Complications
  • Prone Position*
  • Prospective Studies
  • Retinal Perforations / surgery*
  • Visual Acuity / physiology
  • Vitrectomy / adverse effects
  • Vitrectomy / methods*