TY - JOUR
T1 - Role of Positioning after Full-Thickness Macular Hole Surgery
T2 - A Systematic Review and Meta-Analysis
AU - Chaudhary, Varun
AU - Sarohia, Gurkaran S.
AU - Phillips, Mark R.
AU - Zeraatkar, Dena
AU - Xie, Jim S.
AU - Nanji, Keean
AU - Mustafa, Reem A.
AU - Kaiser, Peter K.
AU - Loewenstein, Anat
AU - Garg, Sunir J.
AU - Bakri, Sophie J.
AU - Holz, Frank G.
AU - Sivaprasad, Sobha
AU - Bhandari, Mohit
AU - Steel, David H.
AU - Wykoff, Charles C.
N1 - Publisher Copyright:
© 2022 American Academy of Ophthalmology
PY - 2023/1
Y1 - 2023/1
N2 - Topic: The importance of postoperative 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 were collected for 7 clinically important outcomes after macular hole surgery: closure rate, visual acuity (VA) improvement, recurrence of FTMH, visual function, quality of life, patient satisfaction, and complication rates. We used the Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias and followed the Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty in the evidence across outcomes. We conducted meta-analyses using random-effects modeling. Subgroup analyses were carried out based on hole size, type of gas, and duration of FDP. Results: Eight RCTs of 709 eyes were included. The relative risk (RR) of FTMH closure rate comparing FDP versus nFDP was RR 1.05 (95% confidence interval [CI]: 0.99, 1.12, P = 0.09, I2 = 44%, GRADE rating: LOW). The mean difference (MD) regarding VA improvement comparing FDP and nFDP was MD −0.07 (95% CI: −0.12 to 0.01, P = 0.03, I2 = 16%, GRADE rating: LOW). Conclusion: The current review did not demonstrate a difference between FDP and nFDP with respect to FTMH closure, although the CIs were wide. There was a visual benefit to FDP; however, the CIs included values of trivial clinical significance. Subgroup analyses demonstrated that the VA benefit observed was driven by large holes. Limited data precluded analysis regarding the rate of FTMH recurrence, measures of visual function, quality of life measures, and patient satisfaction metrics. Further prospective trials are required to assess the gaps in the literature and improve the certainty of evidence for the outcomes examined.
AB - Topic: The importance of postoperative 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 were collected for 7 clinically important outcomes after macular hole surgery: closure rate, visual acuity (VA) improvement, recurrence of FTMH, visual function, quality of life, patient satisfaction, and complication rates. We used the Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias and followed the Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty in the evidence across outcomes. We conducted meta-analyses using random-effects modeling. Subgroup analyses were carried out based on hole size, type of gas, and duration of FDP. Results: Eight RCTs of 709 eyes were included. The relative risk (RR) of FTMH closure rate comparing FDP versus nFDP was RR 1.05 (95% confidence interval [CI]: 0.99, 1.12, P = 0.09, I2 = 44%, GRADE rating: LOW). The mean difference (MD) regarding VA improvement comparing FDP and nFDP was MD −0.07 (95% CI: −0.12 to 0.01, P = 0.03, I2 = 16%, GRADE rating: LOW). Conclusion: The current review did not demonstrate a difference between FDP and nFDP with respect to FTMH closure, although the CIs were wide. There was a visual benefit to FDP; however, the CIs included values of trivial clinical significance. Subgroup analyses demonstrated that the VA benefit observed was driven by large holes. Limited data precluded analysis regarding the rate of FTMH recurrence, measures of visual function, quality of life measures, and patient satisfaction metrics. Further prospective trials are required to assess the gaps in the literature and improve the certainty of evidence for the outcomes examined.
KW - Macular hole
KW - Positioning
KW - Retina
KW - Retinal surgery
KW - Vitrectomy
KW - Eye
KW - Prone Position
KW - Humans
KW - Retinal Perforations/diagnosis
KW - Visual Acuity
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U2 - 10.1016/j.oret.2022.06.015
DO - 10.1016/j.oret.2022.06.015
M3 - Review article
C2 - 35781067
AN - SCOPUS:85144722764
SN - 2468-6530
VL - 7
SP - 33
EP - 43
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 1
ER -