Nonsupine positioning is preferred by patients over face-down positioning and provides an equivalent closure rate in 25- and 23-gauge macular hole surgery.

Purpose: Strict face-down positioning after macular hole surgery is very difficult for most patients. Our study seeks to determine if alleviated positioning (avoidance of supine positioning) has equivalent successful closure rates when compared with face-down positioning. A patient survey was also performed to determine patient preference.

Methods: A single-center retrospective review of patients undergoing macular hole repair with a questionnaire completed by each patient after air bubble clearance summarizing the two postoperative scenarios. Patients were asked which positioning strategy they would choose if they were having repeat surgery. Eighty-two patients undergoing pars plana vitrectomy with primary full-thickness macular hole repair were identified. Repair was performed with either 3 days of strict face-down positioning (57 of 82 patients) or with the avoidance of supine positioning (25 of 82 patients) but no required face-down positioning.

Results: The anatomical success rates were similar between the 2 groups with 96% of final hole closure (55/57) in the face-down group versus 100% (25/25) in the nonsupine group. Macular hole size appeared to be similar between the 2 groups (a mean of 408 μm in face-down group vs. that of 483 μm in nonsupine group, with a median of 400 in both groups). Patient preference was in favor of less stringent nonsupine postoperative requirements. Although 100% (25/25) of the nonsupine group would opt for the same strategy with repeat surgery, only 51% (29/57) of the face-down group would opt for face-down positioning with repeat surgery (P < 0.001).

Conclusion: This study demonstrates equivalent closure rates among the patients who were assigned nonsupine versus face-down positioning postoperatively for macular hole repair, and that most patients would prefer to avoid strict face-down positioning if reoperated.