Jan-Olof Carlsson


To evaluate the possibility of abandon face down positioning in order to widen the indications for idiopathic macular hole surgery and to facilitate the postoperative period without compromising the success rate.


One experienced surgeon, using a standard 3-port vitrectomy, ILM peeling and fluid-gas exchange, performed all operations. The eyes were filled with gas tamponade. In order to have as complete gas filling as possible, a peripheral vitrectomy was performed using indentation technique. Nearly all patients were made pseudofacic prior to the vitrectomy. The patients were told to avoid supine position for 2 weeks, but there were no other demands for positioning. A case series of 132 consecutive eyes have now been operated. 121 eyes have been evaluated for anatomical success.


120 eyes have a closed macular hole at one operation (99,2%). One eye went through a renewed gas filling which also resulted with a closure. Visual results and complications at 6 months follow up will be presented.


In macular hole surgery that includes ILM peeling, the face down regime doesn´t seem to be necessary if it is possible to get a sufficient gas-filled eye with an adequate length of time.

Take-home message:

Under certain circumstances, face down positioning is not necessary in idiopathic macular hole surgery.