Nonsupine positioning after macular hole surgery: A prospective multicenter study

Purpose To evaluate the postoperative closure rate of full-thickness macular holes (MHs) after nonsupine positioning, which means that the patients avoid upward gaze and a supine sleeping position, and to investigate the correlation between postoperative positioning compliance and closure rate. Design Prospective, multicenter study (ClinicalTrials.gov identifier, NCT02295943). Participants Patients undergoing primary surgery for primary MH. Methods Patients underwent pars plana vitrectomy with internal limiting membrane peeling and sulfur hexafluoride gas tamponade followed by 3 to 5 days of nonsupine positioning. A positioning measuring device that recorded the time spent in the supine position was attached to patients’ forehead after surgery for 24 hours. Main Outcome Measures Anatomic closure rate of MH at 2 weeks or more after surgery and the time spent in supine position during the first 24 hours after surgery. Results A total of 205 participants were included, of whom 2 were lost to follow-up. Two hundred two of 203 MHs closed after a single operation, giving a closure rate of 99.5% (95% confidence interval, 97.3%–99.9%). The median time of supine positioning during the first 24 hours was 28 seconds (range, 0:00:00–01:52:28). Because of the very high closure rate, a correlation between positioning compliance and closure rate could not be established. Conclusions Pars plana vitrectomy with internal limiting membrane peeling followed by a short-term nonsupine positioning accomplished a very high MH closure rate. Thus, face-down positioning was not necessary to achieve excellent closure rates in this study.