Audit: Face-down positioning for macular hole repair unnecessary
SAN DIEGO – Face-down posturing made no difference in recovery after macular hole surgery, according to a speaker here.
Using data from the first 400 cases entered in prospective registry-style audit database of patients undergoing macular hole repair in Australia, Alex Hunyor, MD, and colleagues determined that no posturing was noninferior to face-down posturing with regard to outcomes.
Noninferiority was qualified as “not less than 90% hole closure rate,” assuming a standard hole closure rate of 95%. In this macular hole project, 48 surgeons participated, using a variety of positioning protocols.
“One of the big areas of missing data at the moment is hole size, particularly early in the series, when we asked only for stage of the hole and an OCT,” Hunyor said at the American Society of Retina Specialists annual meeting. However, only cases with complete data were included in the presentation.
Hole closure data are now available on 1,820 patients, that is, 90% of the intended population of 2,020 patients in the registry. Overall, 80% of cases were performed with some variation of face-down posturing, but so far in 2014, that percentage is only 60%. Primary hole closure has been achieved in 95% of patients, Hunyor said, regardless of positioning.
“In terms of factors for success, there’s not really any great surprise here,” Hunyor said. “The holes with longer duration and larger size holes, as has been found in other studies, negatively correlated with success, whereas ILM peeling was strongly positively correlated with success.”
Disclosure: Hunyor has no relevant financial disclosures.