Face-down or no face-down posturing following macular hole surgery: a meta-analysis

To evaluate the impact of postoperative posturing with or without face-down on the anatomical and functional outcomes of macular hole surgery. A literature-based meta-analysis was conducted to identify studies relevant to posturing following macular hole surgery (MHS). PubMed and Web of Science databases were used to retrieve articles up to 1 June 2015. The primary measures included MH closure and ideal vision acuity improvement. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated in Review Manager. Four randomized control trials (RCTs) comprising 251 cases were included in the final meta-analysis. No face-down posturing (FDP) after MHS revealed lower anatomic success rate compared to face-down posturing (OR = 0.33, 95% CI [0.13, 0.81], p = 0.02). For holes smaller than 400 mu m in size, the subgroup meta-analysis indicated no significant effect of FDP on successful hole closure (OR = 0.29, 95% CI [0.01, 7.34], p = 0.45). However, when holes were larger than 400 mu m, it seemed less effective on MH closure following surgery in no FDP group (OR = 0.23, 95% CI [0.07, 0.71]), and this was statistically significant (p = 0.01). Our work found that no FDP was not inferior to its face-down counterpart for the success of MHS when macular holes were smaller than 400 mu m in size. For macular holes larger than 400 mu m, statistical analysis proved that FDP might be necessary. More well-conducted randomized control trials are needed to verify our findings.