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Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

BACKGROUND: After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomforta...

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Autores principales: Ye, Ting, Yu, Ji-guo, Liao, Lin, Liu, Lan, Xia, Ting, Yang, Lei-lei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925505/
https://www.ncbi.nlm.nih.gov/pubmed/31864333
http://dx.doi.org/10.1186/s12886-019-1272-1
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author Ye, Ting
Yu, Ji-guo
Liao, Lin
Liu, Lan
Xia, Ting
Yang, Lei-lei
author_facet Ye, Ting
Yu, Ji-guo
Liao, Lin
Liu, Lan
Xia, Ting
Yang, Lei-lei
author_sort Ye, Ting
collection PubMed
description BACKGROUND: After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery. METHODS: Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. RESULTS: Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 μm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 μm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). CONCLUSIONS: Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 μm but may be highly recommended for MHs larger than 400 μm. Further RCTs with large sample sizes are warranted to validate these findings in future.
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spelling pubmed-69255052019-12-30 Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials Ye, Ting Yu, Ji-guo Liao, Lin Liu, Lan Xia, Ting Yang, Lei-lei BMC Ophthalmol Research Article BACKGROUND: After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery. METHODS: Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. RESULTS: Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 μm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 μm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). CONCLUSIONS: Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 μm but may be highly recommended for MHs larger than 400 μm. Further RCTs with large sample sizes are warranted to validate these findings in future. BioMed Central 2019-12-21 /pmc/articles/PMC6925505/ /pubmed/31864333 http://dx.doi.org/10.1186/s12886-019-1272-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ye, Ting
Yu, Ji-guo
Liao, Lin
Liu, Lan
Xia, Ting
Yang, Lei-lei
Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title_full Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title_fullStr Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title_full_unstemmed Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title_short Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
title_sort macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925505/
https://www.ncbi.nlm.nih.gov/pubmed/31864333
http://dx.doi.org/10.1186/s12886-019-1272-1
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