Spectral domain optical coherence tomography-guided versus 1-week facedown-posturing after macular hole surgery

Abstract Objective To compare idiopathic full-thickness macular hole (FTMH) closure rates and postoperative best-corrected visual acuity (BCVA) between spectral domain optical coherence tomography (SD-OCT)–guided facedown posturing and conventional 1-week facedown posturing after macular hole surgery. Design A retrospective comparative study. Participants Thirty-one consecutive eyes that underwent surgery for FTMH between July 2013 and September 2014 were divided into 2 groups. Methods In the SD-OCT-guided group, SD-OCT was performed on the first day after surgery. If the macular hole was closed, the patient could assume any position but supine. If the hole was not closed on postoperative day 1, SD-OCT was performed daily for 1 week until the hole was closed, at which point the patient was asked to stop positioning. For the control group, patients were asked to keep facedown posturing for 1 week after surgery. Results Mean length of follow-up for the SD-OCT-guided group and the control group was 188.3 (SD = 74.6) days and 216.7 (SD = 71.2) days, respectively. FTMH closure rate was 100% for both groups. Mean time for FTMH closure in the SD-OCT group was 1.2 days. There was no statistical difference in postoperative BCVA at the last visit between SD-OCT-guided (0.49 ± 0.3 logMAR) and control (0.50 ± 0.4 logMAR; p = 0.9422) groups. Conclusions No difference in FTMH closure rates was detected between the SD-OCT-guided facedown posturing group and the control group. SD-OCT-guided posturing may be used to shorten facedown positioning while maintaining a high success rate.