Face-down or no face-down posturing following macular hole surgery: a meta-analysis

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To evaluate the impact of postoperative posturing with or without face-down on the anatomical and functional outcomes of macular hole surgery.


A literature-based meta-analysis was conducted to identify studies relevant to posturing following macular hole surgery (MHS). PubMed and Web of Science databases were used to retrieve articles up to 1 June 2015. The primary measures included MH closure and ideal vision acuity improvement. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated in Review Manager.


Four randomized control trials (RCTs) comprising 251 cases were included in the final meta-analysis. No face-down posturing (FDP) after MHS revealed lower anatomic success rate compared to face-down posturing (OR = 0.33, 95% CI [0.13, 0.81], p = 0.02). For holes smaller than 400μm in size, the subgroup meta-analysis indicated no significant effect of FDP on successful hole closure (OR = 0.29, 95% CI [0.01, 7.34], p = 0.45). However, when holes were larger than 400μm, it seemed less effective on MH closure following surgery in no FDP group (OR = 0.23, 95% CI [0.07, 0.71]), and this was statistically significant (p = 0.01).


Our work found that no FDP was not inferior to its face-down counterpart for the success of MHS when macular holes were smaller than 400μm in size. For macular holes larger than 400μm, statistical analysis proved that FDP might be necessary. More well-conducted randomized control trials are needed to verify our findings.

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