Face-down posturing after macular hole surgery: a review.

BACKGROUND: The need to face-down posture (FDP) after macular hole surgery remains a debated and unproven requirement that is associated with complications and can prevent patient eligibility for surgery. The use of FDP is related to the mechanics of the endotamponade agent. The vitreous plays a primary role in the pathogenesis of macular hole formation. Surgery aims to relive vitreous-mediated tractional vectors and stimulate reparative healing mechanisms. The mechanism by which the tamponade agent facilitates macular hole sealing is uncertain. One role of the endotamponade agent is to provide a template over which the nascent bridging preretinal membrane can form. Two possible additional effects are to mechanically tamponade the macula and to isolate the healing macula from vitreous fluid.
METHODS: A literature review with a systematic review of the studies that have investigated nil FDP was undertaken.
RESULTS: A review of macular hole surgery studies that have eliminated FDP or used reduced duration FDP reveals relatively successful outcomes anatomical and visual outcomes.
CONCLUSIONS: Isolating the macula may be the more important role of the endotamponade agent and therefore a large long-acting gas-fill may eliminate the requirement to FDP. Benefits include faster postoperative rehabilitation, improved patient compliance, faster return to work, and an increased number of patients eligible for surgery.