Poster Young-suk Chang

Purpose:

To investigate the optimal duration of postoperative prone positioning after macular hole (MH) surgery by the comparison of the anatomical success rate.

Methods:

The clinical records were reviewed of all patients treated at Kim’s eye hospital between February 1, 2006 and February 28, 201 3, for an idiopathic macular hole. Coexisting ocular disease such as glaucoma, diabetic retinopathy, retinal vessel occlusion, vitreomacular traction syndrome, age-related macular degeneration, secondary macular hole or history of previous intraocular surgery were excluded. 114 eyes of 114 consecutive patients who underwent pars plana vitrectomy, internal limiting membrane peeling, and intraocular gas tamponade (C3F8 or SF6) were included in this study. All patients underwent the same surgical procedure by one surgeon. Postoperatively, the duration of prone positioning were divided into three groups. The first group (33 patients) was instructed to maintain prone positioning for only 1 day. After that, any positioning was allowed except supine position. The second group (32 patients) maintained prone positioning for 3 days. The third group (49 patients) maintained prone positioning for 1 week. The anatomical success rate was evaluated at 2 weeks after the surgical procedure by performing macular OCT. Anatomical success was defined as hole closure including type 1 (hole closure without foveal neurosensory retinal defect) and type 2 (hole closure with foveal neurosensory retinal defect) closure by OCT.

Results:

There were no significant differences between the three groups in terms of age, gender, stage, macular hole size, preoperative visual acuity. Intra-operative factors possibly affecting the hole closure rate such as the operator, use of dye for ILM peeling, concentration and type of gas did not differ significantly between the three groups (p>0.05). The MH sealed successfully in 27 (81.8%) of the 33 eyes in the 1 day group, 30 (93.8%) of the 32 eyes in the 3 day group and 47 (95.9%) of the 49 eyes in the 1 week group. (P=0.043, between 1 day group & 1 week group) The 10 cases that failed were adequately managed by additional fluid-gas exchange and secondary operation, and were closed eventually.

Conclusion:

The anatomical success rate according to the period of postoperative prone position was investigated. The significantly inferior anatomical success rate of 1 day prone position group than that of 1 week prone position group suggest that maintaining prone position for 1 day may not be sufficient to achieve complete hole closure. At least 1 week of postoperative prone position period will be recommended.