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Review
. 2019 Jan 28;19(1):34.
doi: 10.1186/s12886-019-1047-8.

Comparison of face-down posturing with nonsupine posturing after macular hole surgery: a meta-analysis

Song Xia  1 , Xin-Yu Zhao  2 , Er-Qian Wang  2 , You-Xin Chen  3
Affiliations
Review

Comparison of face-down posturing with nonsupine posturing after macular hole surgery: a meta-analysis

Song Xia et al. BMC Ophthalmol. .

Abstract

Background: 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.

Methods: The 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.

Results: Our 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).

Conclusion: Based 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.

Keywords: Face-down; Macular hole; Meta-analysis; Posturing.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

One of the authors, Youxin Chen, is a member of the editorial board of BMC ophthalmology. No other competing interests exist.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart depicting the selection of included studies
Fig. 2
Fig. 2
Comparison of the macular hole closure rate in the face-down posturing group and nonsupine posturing group
Fig. 3
Fig. 3
Comparison of the macular hole closure rate with a size greater than 400 μm in the face-down posturing group and nonsupine posturing group
Fig. 4
Fig. 4
Comparison of the macular hole closure rate with the macular hole size smaller than 400 μm in the face-down posturing group and nonsupine posturing group
Fig. 5
Fig. 5
Comparison of the ideal visual acuity improvement rate in the face-down posturing group and nonsupine posturing group
See this image and copyright information in PMC

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