gms | German Medical Science

23rd Annual Meeting of the German Retina Society

German Retina Society

24.09. - 25.09.2010, Freiburg

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Pilot randomized controlled trial of face-down positioning following macular hole surgery

Meeting Abstract

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  • Clemens Lange - Moorfields Eye Hospital, London (GB)
  • L. Membrey - Moorfields Eye Hospital, London (GB)
  • N. Ahmad - Moorfields Eye Hospital, London (GB)
  • L. Wickham - Moorfields Eye Hospital, London (GB)
  • R. Maclaren - Moorfields Eye Hospital, London (GB)
  • L. Solebo - Moorfields Eye Hospital, London (GB)
  • W. Xing - Institute of Child Health, University College London (GB)
  • C. Bunce - Moorfields Eye Hospital, London (GB)
  • E. Ezra - Moorfields Eye Hospital, London (GB)
  • D. Charteris - Moorfields Eye Hospital, London (GB)
  • B. Aylward - Moorfields Eye Hospital, London (GB)
  • Z. Gregor - Moorfields Eye Hospital, London (GB)
  • H. Zambarakji - Moorfields Eye Hospital, London (GB)
  • J. Bainbridge - Whipps Cross Hospital London (GB)

German Retina Society. 23rd Annual Conference of the German Retina Society. Freiburg i. Br., 24.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10rg66

doi: 10.3205/10rg66, urn:nbn:de:0183-10rg665

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/rg2010/10rg66.shtml

Published: September 21, 2010

© 2010 Lange et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Background: The aim of this pilot randomized controlled trial (RCT) was to explore the feasibility of a definitive study to determine the value of face-down positioning following macular hole surgery.

Methods: Thirty subjects underwent complete 20-gauge 3-port-pars-plana vitrectomy with trypan-blue assisted peeling of the inner limiting membrane and injection of 14% perfluoropropane gas. At the completion of surgery subjects were randomly allocated to a 10-days-posturing or a non-posturing group. The primary outcome was anatomical closure assessed 6 weeks following surgery by biomicroscopy and on ocular coherence tomography by two masked consultant retinal surgeons.

Results: We observed an anatomic closure of macular holes in 14 of 15 eyes (93.3%, 95% confidence interval (95% CI) 68–100%) in the posturing group, and in 9 of 15 eyes (60%, 95% CI 32–84%) in the non-posturing group (Fisher's exact test; p=0.08). In a subgroup analysis of outcome according to macular hole size, all holes smaller than 400 µm closed regardless of posturing (100%). In contrast, macular holes larger than 400 µm were closed in 10 of 11 eyes (91%, 95% CI 58–99%) in the posturing group closed and only 4 of 10 (40%, 95% CI 12–74%) eyes in the non-posturing group (p=0.02).

Conclusion: The results of this pilot RCT suggest that postoperative face-down positioning can improve the likelihood of macular hole closure. This benefit appears to be relevant to macular holes of greater than 400 µm in diameter and is not apparent in holes smaller than 400 µm. These results suggest that a definitive RCT to determine the value of posturing in large macular holes specifically would require fewer subjects than a trial including macular holes of all sizes.