Abstract
BackgroundA few randomized controlled trials (RCTs) have evaluated face-down posturing (FDP) with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness macular holes (MHs). The objective of our study was to evaluate the efficacy of postoperative posturing on the anatomical and functional outcomes of MH surgery.MethodsThe PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from their earliest entries through December 2016 to identify the studies that had evaluated the effects of postoperative posturing with FDP or NSP for patients with MH surgery. The PRISMA guidelines were followed. The relevant data were analyzed using StataSE 12.0 software. The weighted mean difference (WMD), relative risk (RR) and their 95% confidence intervals (95% CIs) were used to assess the strength of the association.ResultsOur search yielded 181 records from which 11 studies comprising 726 cases that had examined the effects of postoperative posturing with FDP for patients compared with NSP after MH surgery were included for review and analysis. Our meta-analyses showed that postoperative FDP could generally improve the overall MH closure rate compared to NSP (OR = 1.828, 95% CI: 1.063~3.143, P = 0.029). Subgroup analysis of the size of MH suggested a significant benefit of FDP for large MHs (≥400 μm) (OR = 4.361, 95% CI: 1.429~13.305, P = 0.010) while there was no difference in the MH closure rate for small MHs (< 400 μm) (OR = 1.731, 95% CI: 0.412~7.270, P = 0.453). Moreover, ILM peeling for large MHs could significantly increase the MH closure rate of the FDP group (OR = 2.489, 95% CI: 1.021~6.069, P = 0.045), while no difference existed for small MHs (OR = 3.572, 95% CI: 0.547~23.331, P = 0.184). Combined cataract surgery might not influence the MH closure rate under any circumstance (OR = 0.513, 95% CI: 0.089~2.944, P = 0.454).ConclusionBased on all the available evidence, our study found that FDP after MH surgery could generally improve the overall MH closure rate compared to NSP. For MHs larger than 400 μm, ILM peeling combined with FDP could significantly increase the MH closure rate. Combined cataract surgery might not influence the MH closure rate.
Highlights
Idiopathic full-thickness macular holes (MHs) are one of the most significant causes of visual loss
A few randomized controlled trials (RCTs) have evaluated face-down posturing (FDP) with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness MHs, and some of them suggested a significant benefit of FDP, while others suggested that FDP is unnecessary [6,7,8,9,10]
Our study showed that postoperative FDP could generally improve the overall MH closure rate compared to the NSP group
Summary
Idiopathic full-thickness macular holes (MHs) are one of the most significant causes of visual loss. With the significant progress in surgical techniques, such as internal limiting membrane (ILM) peeling and combined cataract surgery, hole closure rates have improved from 58 to 100%, as reported in recent studies [4,5,6]. A few randomized controlled trials (RCTs) have evaluated FDP with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness MHs, and some of them suggested a significant benefit of FDP, while others suggested that FDP is unnecessary [6,7,8,9,10]. A few randomized controlled trials (RCTs) have evaluated face-down posturing (FDP) with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness macular holes (MHs). The objective of our study was to evaluate the efficacy of postoperative posturing on the anatomical and functional outcomes of MH surgery
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