POSTOPERATIVE POSITIONING IN MACULAR HOLE SURGERY: An Objective Evaluation of Nonsupine Positioning and the Effect of the “Tennis Ball Technique”

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To objectively evaluate patients' compliance with a nonsupine positioning (NSP) regimen after macular hole surgery and to investigate whether supine positioning time during the first postoperative nights is reduced when a tennis ball is mounted onto the back of the nightshirt.


A “position monitoring device” capable of recording the time the head is kept in a supine position was attached to the patient's forehead. In a randomized, controlled, crossover study, the accumulated time each patient spent in a supine position was recorded during two consecutive postoperative nights, both when the “tennis ball technique” (TBT) was used and when it was not, respectively.


The study included 40 participants. A mean supine time of 14 minutes and 47 seconds was registered with the NSP regimen. When applying the TBT, the mean supine time was significantly reduced to 4 minutes and 24 seconds (P = 0.01). Seven “noncompliant” participants with >30 minutes supine time without TBT had the most marked reduction in supine time from a mean of 63 minutes and 2 seconds, to 3 minutes and 46 seconds, with TBT (P = 0.02).


During an NSP regimen, patients generally maintain a high level of compliance after macular hole surgery. The TBT further improves their compliance significantly.

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