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DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY

Sano, Masahiko MD; Inoue, Makoto MD; Itoh, Yuji MD; Kita, Yoshiyuki MD; Hirota, Kazunari MD; Koto, Takashi MD; Hirakata, Akito MD

doi: 10.1097/IAE.0000000000001394
Original Study
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Purpose: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning.

Methods: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeon's decision (conventional group). The MH closure rate and duration of the prone positioning were compared.

Results: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001).

Conclusion: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

The halting of prone positioning after macular hole surgery by monitoring the closure by swept-source optical coherence tomography can decrease the duration of the prone positioning with identical macular hole closure rates and visual outcome compared with the conventional decision of prone positioning by the surgeons.

Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan.

Reprint requests: Makoto Inoue, MD, Kyorin Eye Center, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan; e-mail: inoue@eye-center.org

None of the authors has any financial/conflicting interests to disclose.

M. Sano, M. Inoue, Y. Itoh, and K. Hirota involved in management, analysis, interpretation, and preparation of the data. M. Sano, M. Inoue, and A. Hirakata involved in interpretation and preparation of the manuscript.

The study and data accumulation were carried out with approval from the Institutional Review Board of the Kyorin University School of Medicine and conformed to the tenets of the Declaration of Helsinki. Informed consent for the research was obtained from all patients. This clinical study has been registered at the United States National Institutes of Health (www.clinicaltirals.gov) as “Optical Coherence Tomography-based Positioning for Macular Hole Surgery,” with a reference number of NCT02650739.

© 2017 by Ophthalmic Communications Society, Inc.