To evaluate the success rate of surgical repair of full-thickness macular holes without face-down positioning in a large series.


A retrospective chart review of 81 consecutive patients with idiopathic full-thickness macular holes <750m in diameter were treated with standard surgical techniques by a single surgeon (PET). Surgical technique included 23-gauge pars plana vitrectomy, ICG-assisted peeling of the internal limiting membrane, and fluid-gas exchange with 25% SF6 gas. All patients were either pseudophakic or rendered pseudophakic at the time of surgery. None of the patients were instructed to position face down at any time. Post-operative optical coherence tomography was obtained on all patients to document hole closure and as needed thereafter. Charts were reviewed for anatomic hole closure, best corrected final visual acuity, and the incidence of retinal detachment.


The single operation success rate for macular hole closure was 97%. Visual acuity of 20/50 or better was attained in 84% of eyes. The incidence of retinal detachment was 3%.


Face down positioning is not necessary to successfully close macular holes, and substantially adds to the post-operative burden of patients.