Face-down posturing after idiopathic macular hole surgery: a meta-analysis_Chinese Journal of Ocular Fundus Diseases

Authors：

XiaHonghe ,  ChenHaoyu , Pengkun , 郑康铿

Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515041, China;

Corresponding author：

ChenHaoyu, Email: jsieczjf@163.com

Keywords：

Diabetic retinopathy/surgery; Prone position; Meta-analysis

DOI：

10.3760/cma.j.issn.1005-1015.2015.04.021

Video：

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Objective To evaluate the full thickness idiopathic macular hole (IMH) closure rates in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). Methods A computerized search was conducted in the PubMed, Chinese Biomedical Database, China National Knowledge Infrastructure, and VIP database. All the included studies were divided into NSP and FDP group. A total of 9 papers were included in this meta analysis, including 285 eyes (145 eyes with small hole ≤400 μm, 104 eyes with large hole >400 μm) in NSP group and 303 eyes (141 eyes with small hole and 124 eyes with large hole ). RevMan 4.2 software was applied for investigating heterogeneity and meta-analysis, and the risk of publication bias was evaluated. Results Meta analysis indicated that there was statistical significance on closure rates betwen NSP and FDP group. The difference of closure rates in small macular hole eyes between NSP and FDP group was statistically significant (OR=0.45, 95%CI 0.13-1.51;P=0.20). The difference of closure rates in large macular hole eyes between NSP and FDP group was statistically significant (OR=0.35, 95%CI 0.17-0.75;P=0.006). Conclusion NSP is equally effective as strict FDP in the repair of small macular hole. Post-operative FDP may improve the macular hole closure rates for holes larger than 400 μm.

Citation： XiaHonghe, ChenHaoyu, Pengkun. Face-down posturing after idiopathic macular hole surgery: a meta-analysis. Chinese Journal of Ocular Fundus Diseases, 2015, 31(4): 389-393. doi: 10.3760/cma.j.issn.1005-1015.2015.04.021 Copy

1.	Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes:results of a pilot study[J]. Arch Ophthalmol,1991,109(5):654-659.
2.	Benson WE, Cruickshanks KC, Fong DS, et al. Surgical management of macular holes: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2001, 108 (7):1328-1335.
3.	Kim JW, Freeman WR, Azen SP, et al. Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Vitrectomy for Macular Hole Study Group[J]. Am J Ophthalmol,1996, 121(6):605-614.
4.	Freeman WR, Azen SP, Kim JW, et al. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes: results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group[J]. Arch Ophthalmol, 1997,115(1):11-21.
5.	Verma D, Jalabi MW, Watts WG, et al. Evaluation of posturing in macular hole surgery[J]. Eye (Lond),2002,16(6):701-704.
6.	Krohn J. Topical medication interferes with face-down positioning after macular hole surgery[J]. Acta Ophthalmol Scand,2003,81(3):226-229.
7.	Sutter FK, Smorgon A, McClellan K. Acute angle closure in the fellow eye as a complication of prone positioning after vitreoretinal surgery[J]. Arch Ophthalmol, 2003,121(7): 1057.
8.	Sato H, Kawasaki R, Yamashita H. Observation of idiopathic full-thickness macular hole closure in early postoperative period as evaluated by optical coherence tomography[J]. Am J Ophthalmol,2003,136(1):185-187.
9.	Tornambe PE, Poliner LS, Grote K. Macular hole surgery without face-down positioning:a pilot study[J]. Retina,1997,17(3):179-185.
10.	Ellis JD, Baines PS. Patient perspectives on macular hole surgery[J]. Ophthalmology,2002, 109(4):622-623.
11.	Simcock PR, Scalia S. Phacovitrectomy without prone posture for full-thickness macular holes[J]. Br J Ophthalmol,2001,85(11):1316-1319.
12.	Tranos PG, Peter NM, Nath R, et al. Macular hole surgery without prone positioning[J]. Eye (Lond),2007,21(6): 802-806.
13.	Yorston D, Siddiqui MA, Awan MA, et al. Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole[J]. Eye (Lond),2012,26(2):267-271.
14.	Forsaa VA, Raeder S, Hashemi LT, et al. Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery[J]. Acta Ophthalmol,2013,91(6):547-551.
15.	Alberti M, la Cour M. Face-down positioning versus non-supine positioning in macular hole surgery[J]. Br J Ophthalmol,2015,99(2):236-239.
16.	Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole[J]. Am J Ophthalmol, 1995,119(6):752-759.
17.	Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial[J]. Am J Ophthalmol,2008, 146(1):128-134.
18.	Tadayoni R, Vicaut E, Devin F, et al. A randomized controlled trial of alleviated positioning after small macular hole surgery[J].Ophthalmology,2011,118(1):150- 155.
19.	Lange CA, Membrey L, Ahmad N, et al. Pilot randomised controlled trial of face-down positioning following macular hole surgery[J]. Eye (Lond),2012,26(2): 272-277.
20.	张楠,朱冬梅,张钊填,等.特发性黄斑裂孔术后面向下体位及端坐位疗效比较[J].中国实用眼科杂志,2014,32(6):708-711.
21.	Krohn J. Duration of face-down positioning after macular hole surgery: a comparison between 1 week and 3 days[J]. Acta Ophthalmol Scand,2005,83(3): 289-292.
22.	Christensen UC, Krøyer K, Sander B, et al. Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial[J]. Br J Ophthalmol,2009,93(8):1005-1015.
23.	Lois N, Burr J, Norrie J, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomised controlled trial[J]. Invest Ophthalmol Vis Sci,2011,52(3):1586-1592.
24.	Thompson JT, Smiddy WE, Glaser BM, et al. Intraocular tamponade duration and success of macular hole surgery[J]. Retina,1996,16(5):373-382.
25.	Eckardt C, Eckert T, Eckardt U,et al. Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning[J]. Retina,2008,28(8): 1087-1096.
26.	Gesser C, Eckert T, Eckardt U, et al. Macular hole surgery with air tamponade: does air suffice for short-term tamponade?[J].Ophthalmologe,2010,107(11): 1043-1050.

1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes:results of a pilot study[J]. Arch Ophthalmol,1991,109(5):654-659.
2. Benson WE, Cruickshanks KC, Fong DS, et al. Surgical management of macular holes: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2001, 108 (7):1328-1335.
3. Kim JW, Freeman WR, Azen SP, et al. Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Vitrectomy for Macular Hole Study Group[J]. Am J Ophthalmol,1996, 121(6):605-614.
4. Freeman WR, Azen SP, Kim JW, et al. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes: results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group[J]. Arch Ophthalmol, 1997,115(1):11-21.
5. Verma D, Jalabi MW, Watts WG, et al. Evaluation of posturing in macular hole surgery[J]. Eye (Lond),2002,16(6):701-704.
6. Krohn J. Topical medication interferes with face-down positioning after macular hole surgery[J]. Acta Ophthalmol Scand,2003,81(3):226-229.
7. Sutter FK, Smorgon A, McClellan K. Acute angle closure in the fellow eye as a complication of prone positioning after vitreoretinal surgery[J]. Arch Ophthalmol, 2003,121(7): 1057.
8. Sato H, Kawasaki R, Yamashita H. Observation of idiopathic full-thickness macular hole closure in early postoperative period as evaluated by optical coherence tomography[J]. Am J Ophthalmol,2003,136(1):185-187.
9. Tornambe PE, Poliner LS, Grote K. Macular hole surgery without face-down positioning:a pilot study[J]. Retina,1997,17(3):179-185.
10. Ellis JD, Baines PS. Patient perspectives on macular hole surgery[J]. Ophthalmology,2002, 109(4):622-623.
11. Simcock PR, Scalia S. Phacovitrectomy without prone posture for full-thickness macular holes[J]. Br J Ophthalmol,2001,85(11):1316-1319.
12. Tranos PG, Peter NM, Nath R, et al. Macular hole surgery without prone positioning[J]. Eye (Lond),2007,21(6): 802-806.
13. Yorston D, Siddiqui MA, Awan MA, et al. Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole[J]. Eye (Lond),2012,26(2):267-271.
14. Forsaa VA, Raeder S, Hashemi LT, et al. Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery[J]. Acta Ophthalmol,2013,91(6):547-551.
15. Alberti M, la Cour M. Face-down positioning versus non-supine positioning in macular hole surgery[J]. Br J Ophthalmol,2015,99(2):236-239.
16. Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole[J]. Am J Ophthalmol, 1995,119(6):752-759.
17. Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial[J]. Am J Ophthalmol,2008, 146(1):128-134.
18. Tadayoni R, Vicaut E, Devin F, et al. A randomized controlled trial of alleviated positioning after small macular hole surgery[J].Ophthalmology,2011,118(1):150- 155.
19. Lange CA, Membrey L, Ahmad N, et al. Pilot randomised controlled trial of face-down positioning following macular hole surgery[J]. Eye (Lond),2012,26(2): 272-277.
20. 张楠,朱冬梅,张钊填,等.特发性黄斑裂孔术后面向下体位及端坐位疗效比较[J].中国实用眼科杂志,2014,32(6):708-711.
21. Krohn J. Duration of face-down positioning after macular hole surgery: a comparison between 1 week and 3 days[J]. Acta Ophthalmol Scand,2005,83(3): 289-292.
22. Christensen UC, Krøyer K, Sander B, et al. Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial[J]. Br J Ophthalmol,2009,93(8):1005-1015.
23. Lois N, Burr J, Norrie J, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomised controlled trial[J]. Invest Ophthalmol Vis Sci,2011,52(3):1586-1592.
24. Thompson JT, Smiddy WE, Glaser BM, et al. Intraocular tamponade duration and success of macular hole surgery[J]. Retina,1996,16(5):373-382.
25. Eckardt C, Eckert T, Eckardt U,et al. Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning[J]. Retina,2008,28(8): 1087-1096.
26. Gesser C, Eckert T, Eckardt U, et al. Macular hole surgery with air tamponade: does air suffice for short-term tamponade?[J].Ophthalmologe,2010,107(11): 1043-1050.

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Chinese Journal of Ocular Fundus Diseases

Face-down posturing after idiopathic macular hole surgery: a meta-analysis

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