Alexandre Guillaubey, (Dijon, France), Pierre-Olivier Lafontaine, MD (Dijon, France), Laure Malvitte, MD (Dijon, France), Jean-Paul Berrod, MD (Nancy, France), Catherine Creuzot, MD (Dijon, France)


To determine the influence of face down position on anatomic and functional results after macular hole (MH) surgery. This prospective randomized clinical trial was performed to evaluate the anatomic and functional results of face down position after MH surgery.


Patients suffering from macular holes were enrolled in this study. Visual acuity was measured before and three months after surgery. Macular OCT was performed before and after surgery. Traumatic MH and MH larger than 800 μm were excluded. Pars plana vitrectomy with separation of the posterior hyaloid membrane, inner limiting membrane peeling and fluidair exchange were performed. A non expanding mixture of air and SF6 was used for pneumatic tamponade in MH less than 500 μm and of air and C2F6 in MH larger than 500 μm. Eyes were randomized in two groups. Patients were asked to keep a semiseated position 10 hours per day for five days in group P0 and face down position group P1.


One hundred and four eyes were enrolled. In the P0 group, closure of the MH at three months occurred in 45/50 eyes (90%). In the P1 group, closure of the MH occurred in 52/54eyes (96%). For MH < 500 μm the success rate was 3 0/32 eyes in group P0 (94%) and 37/38 eyes in group P1 (97%). The difference between groups was not significant. The median of visual acuity increased from 1 to 0.52 logMAR in each group without a statically significant difference  between groups (Wilcoxon test).


The position after macular hole surgery does not seem to have a strong influence on the outcome of the surgery, especially for small size macular holes. Face down position does not improve visual acuity compared to semi-seated position. However a larger series with a longer follow-up is mandatory to confirm these preliminary results.