Macular Hole Surgery and Face-down Posturing

We have recently demonstrated that non-posturing macular hole surgery is just as effective as posturing – this has created real interest among our colleagues in the UK and USA.

Macular Hole Surgery and Face-down Posturing
Is it really necessary in FTMH patients?


Noting that the need for face-down posturing following surgery for full-thickness macular holes (FTMH) larger than 400 µm) remains “the focus of debate,” researchers from Southampton University Hospital in the United Kingdom conducted a retrospective analysis of 220 consecutive patients with FTMH.

All patients underwent vitrectomy, internal limiting membrane peel, and isovolumetric gas tamponade. Phakic patients underwent phacoemulsification and IOL, even in the absence of visually significant cataract. Patients were not asked to posture but were to avoid lying supine for a week. Demographics, as well as preoperative and postoperative complications, were recorded. The size of the hole and postoperative closure were assessed using OCT.

The mean age of patients was 70 years old (range 45-93), and 162 patients (74%) were female. Macular hole size was small (<250 mm) in 36 patients (16%), medium (250-400 mm) in 77 patients (35%), and large (>400 mm) in 107 patients (49%). Primary success (macular hole closed at 3 months after a single procedure) was achieved in 93.5% of patients. Primary success rate was significantly higher in holes <400 µm (97%) compared with holes >400 µm (90%). Success rate did not vary according to age or gender.

The researchers concluded that macular hole surgery is highly successful without face-down posturing. Even in holes larger than 400 mm, “primary success rates in our study are comparable to surgery with posturing.”

The researchers presented their findings at the recent ARVO meeting under the title “Posturing is not required after macular hole surgery.”