The purpose of this study was to compare the efficacy of short-term non-supine positioning (NSP) and strict face-down positioning (FDP) in the repair of macular hole (MH).


We retrospectively reviewed all MH repairs over a 27-month period (2008-2010). Inclusion criteria were idiopathic full thickness stage 2-4 MH treated by a single surgeon with 23-gauge pars plana vitrectomy, internal limiting membrane peeling and gas tamponade, followed by postoperative short-term NSP (for 5 days) or strict FDP (for 3 – 4 days). NSP was achieved by fastening a tennis ball to the back of the nightshirt. Outcome measures were anatomical MH closure verified by optical coherence tomography and postoperative visual acuity.


A total of 67 eyes (64 patients) met the inclusion criteria. The median follow-up period was 6.6 months (range, 4.7-19.8 months). The closure rates following a single operation were 30/33 (90.9%) in the FDP group, and 31/34 (91.2%) in the NSP group, respectively (p=0.97). The FDP group improved 2.9 ETDRS lines, and 23 eyes (69.7%) gained two or more ETDRS lines. The NSP group improved 2.7 ETDRS lines (p=1.00), and 25 eyes (73.5%) gained two or more ETDRS lines. The closure rates in the MH subgroup with diameters larger than 400 ┬Ám were 20/23 (87.0%) and 15/17 (88.2%) in the FDP group and the NSP group, respectively (p=0.96).


The study indicates that short-term NSP is equally effective as strict FDP in the repair of MH. Contrary to previous reports, even large MH did not seem to benefit from FDP.