Comparison of Prone and Seated Position after Vitrectomy for Idiopathic Macular Hole Surgery

Jae Hwi Park; Woo Hyok Chang; Min Sagong

doi:10.3341/jkos.2013.54.11.1723

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Park, Chang, and Sagong: Comparison of Prone and Seated Position after Vitrectomy for Idiopathic Macular Hole Surgery

Original Article

J Korean Ophthalmol Soc 2013;54(11):1723-1730.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1723

Comparison of Prone and Seated Position after Vitrectomy for Idiopathic Macular Hole Surgery

Jae Hwi Park, MD, Woo Hyok Chang, MD, PhD, Min Sagong, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Min Sagong, MD, PhD, Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea, Tel: 82-53-620-4191, Fax: 82-53-626-5936, E-mail: msagong@ynu.ac.kr

Received 5 April 2013 Revised 3 June 2013 Accepted 8 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the anatomical and functional results of vitrectomy for macular hole with and without prone posture.

Methods

We retrospectively reviewed the medical records of 71 eyes of 71 patients who received macular hole repair and were followed up for at least 6 months. The anatomical success, complications, and best corrected visual acuity at post- operative 6 months and last follow-up between patients who were advised to take a prone posture for 1 week (group 1) and patients who were advised to simply avoid the supine position right from the surgery (group 2) were analyzed. Subgroup division analysis according to macular hole size and concurrent phacoemulsification was performed.

Results

Macular hole closure rate was 91.7% (33 of 36 eyes) in group 1 and 88.6% (31 of 35 eyes) in group 2 (p=0.710). The mean visual acuity at final follow-up increased in both groups by 4.75 ± 3.83 and 4.76 ± 2.96 lines, respectively and revealed no statistically significant difference (p = 0.988). Twenty-seven of 36 eyes (75%) in group 1 and 30 of 35 eyes (85.7%) in group 2 underwent concurrent phacoemulsification, and no difference in macular hole closure rate and visual acuity improvement between the two postures was observed.

Conclusions

Favorable anatomical and functional outcomes were achieved without postoperative face-down posturing in the case of phacovitrectomy with wide internal limiting membrane peeling and gas tamponade.

Keywords: Macular hole, Phacovitrectomy, Postoperative posture, Vitrectomy

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Figure 1.

Anatomical success rate between group with macular holes smaller than 400 μm and group with macular holes 400 μm or larger. There was no significant difference between prone and seated position in both groups (Fisher exact test; p = 0.653, p = 1.000).

Figure 2.

Anatomical success rate between phacovitrectomy group and vitrectomy group. There was no significant difference between prone and seated position in both groups (Fisher's exact test & Pearson's Chi-square test; p = 1.00, p = 1.00).

Figure 3.

Postoperative change in visual acuity at 6 month and final follow-up between group with macular holes smaller than 400 μm and group with macular holes 400 μm or larger. There was no significant difference between prone and seated position in each group (Fisher's exact test & Pearson's Chi-square test; p = 0.653, p = 0.629, p = 0.293, p = 0.471).

Figure 4.

Postoperative change in visual acuity between phacovitrectomy group and vitrectomy only group at 6 month and final follow-up. There was no significant difference between prone and seated position in each group at postoperative 6 months and final follow-up (Fisher's exact test & Pearson's Chi-square test; p = 0.542, p = 0.095, p = 0.506, p = 0.158).

Table 1.

Patient demographics and trial data

		Total	Group 1	Group 2	p-value
Total number of eyes		71	36	35
Mean age (years)		63.75 (±6.6)	63.31 (±6.5)	64.20 (±6.8)	0.572
Gender (Men/ Women)		20/51	6/30	14/21
Mean follow-up, months (range)		15.12 (6-36)	18.0 (10-36)	14.1 (6-36)	0.002
Macular hole stage, n (%)					0.271
	Stage II	40 (56.3)	17 (47.2)	23 (65.7)
	Stage III	22 (31)	13 (36.1)	9 (25.7)
	Stage IV	9 (12.7)	6 (16.7)	3 (18.6)
Mean macular hole size (μm)		426.56	457.72	394.51	0.735
Phacovitrectomy, n (%)		57 (80)	27 (75)	30 (85.7)	0.257
Gas tamponade, n (%)					0.443
	SF₆ 20%	54 (76)	26 (72.2)	28 (80)
	C₃F₈ 12%	17 (24)	10 (27.8)	7 (20)
Macular hole closed, n (%)		64 (90)	33 (91.7)	31 (88.6)	0.710

Table 2.

Best corrected visual acuity and the number of eyes showed visual acuity improvement 3 lines or better

Duration	BCVA			BCVA (3 lines or better)
Duration	Group 1	Group 2	p-value^*	Group 1	Group 2	p-value^†
Preoperative	0.99 ± 0.37	0.91 ± 0.35	0.309	—	—	—
6 months	0.57 ± 0.28	0.47 ± 0.32	0.202	21 (58%)	23 (66%)	0.522
Final	0.52 ± 0.28	0.43 ± 0.34	0.230	23 (64%)	24 (69%)	0.677

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; SD = standard deviation.

^* Independent t-test;

^† Pearson's Chi-square test.

Table 3.

Summary of postoperative complications

	Group 1	Group 2	p-value^*
Lens opacity increased, n^† (%)	6/9 (67)	3/5 (60)	—
Posterior capsular opacity, n (%)	7/27 (26)	1/30 (3)	0.478
Posterior synechia, n (%)	1/36 (3)	0/35 (0)	0.021
Postoperative increased IOP, n (%)	0/36 (0)	4/35 (11)	1.000
Total, n (%)	14/36 (39)	8/35 (23)	0.054

^* Fisher's exact test & Pearson's Chi-square test;

^† An increase in lens opacity was defined as an increase ≥ 1 point in ≥ 1 component of the Lens Opacities Classification System 3 scale after 3 months.

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