Role of Positioning after Full-Thickness Macular Hole Surgery: A Systematic Review and Meta-Analysis
Abstract
TOPIC
The importance of post-operative face down positioning (FDP) to achieve anatomic and functional success after full thickness macular hole (FTMH) surgery is explored in this meta-analysis of randomized controlled trials (RCTs).
CLINICAL RELEVANCE
There is considerable variability in clinical practices regarding the need and length of FDP recommended to patients after FTMH surgery. There is also a lack of robust clinical guidelines on the topic. As such, an updated estimate of the effect size of FDP on clinically important outcomes is critical to inform practice METHODS: Ovid MEDLINE, EMBASE, CENTRAL and SCOPUS databases were searched from inception to October 3, 2021, for RCTs evaluating FDP versus non-FDP (nFDP). Data was collected for 7 clinically important outcomes after macular hole surgery: closure rate, visual acuity improvement, recurrence of FTMH, visual function, quality of life, patient satisfaction, complication rates. We used The Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess risk of bias and followed the GRADE approach to assess the certainty in the evidence across outcomes. We conducted meta-analyses using random effects modelling. Subgroup analyses were carried out based on hole size, type of gas, and duration of FDP.
RESULTS
8 RCTs of 709 eyes were included. The relative risk (RR) of FTMH closure rate comparing FDP versus nFDP was RR 1.05 (95% CI 0.99, 1.12, P=0.09, I2 = 44%, GRADE rating: LOW). The Mean Difference (MD) regarding…
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