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Face-down posturing after macular hole surgery: a meta-analysis
  1. Andrew Tatham,
  2. Somnath Banerjee
  1. Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Mr Andrew Tatham, Department of Ophthalmology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; andrewtatham{at}


Aims To assess the effect that the duration of face-down posturing has on the outcome of macular hole surgery.

Methods A literature search was conducted to identify studies related to posturing duration following macular hole surgery. Where appropriate, studies were compared in a meta-analysis. The Mantel–Haenszel fixed-effect method was used to calculate the summary statistics. The main outcome measures were macular hole closure rate and visual acuity improvement.

Results 17 studies investigating the effect of face-down posturing time on the outcome of macular hole surgery were identified. 9 studies included a comparison group and were deemed suitable for inclusion in the meta-analysis. Studies were divided into two groups depending on the duration of face-down posturing investigated. The meta-analysis revealed an RR of anatomical failure of 1.34 (95% CI 0.66 to 2.72) with face-down posturing for 24 h or less compared with face-down posturing for 5–10 days, but this was not statistically significant (p=0.42). The study design was too dissimilar to allow a meaningful comparison of visual acuity outcomes.

Conclusions Currently there is insufficient evidence to allow firm conclusions as to whether face-down posturing following macular hole surgery influences hole closure rates. Meta-analyses are limited by the quality of included studies; a well-conducted randomised control trial is needed.

  • Macular hole
  • posturing
  • meta-analysis
  • vitreous
  • retina

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  • Meeting presentation: The results of this meta-analysis were presented at the Annual Meeting of the British and Eire Vitreo Retinal Society, November 2008.

  • Both authors have contributed to the design and writing of this manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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