El Rayes, professor of ophthalmology, retina department Institute of Ophthalmology, Cairo, Egypt. “Then, surgeons speaking to elderly patients are more likely to encourage their acceptance of the macular hole procedure by saying, ‘For 1 week, you should stay sitting or sleep on your side opposite to the side of your surgery, but not on your back’ than to say, ‘You have to stay strictly in a face-down position’,” said Dr. Sponsored: Heading to AAO? Join us for dinner! Phacoemulsification is also performed to avoid cataractous changes and maintain optical clarity. ![]() El Rayes said that vitrectomy with internal limiting membrane (ILM) peeling and 95% gas fill provides the conditions needed for success-these techniques increase retinal elasticity, keep the edges of the hole dry for at least 7 days without supine positioning, and trigger and support the process of retinal healing. However, he still advises patients about postoperative positioning, telling them to avoid lying supine on their backs, but that it is okay to sit or sleep on their side.ĭr. Recent: Updated classification gives order to corneal dystrophy El Rayes, MD, PhD, offered a somewhat different perspective on the issue of face-down positioning after macular hole surgery that is based on his review of outcomes data, knowledge about mechanisms of macular hole closure and healing, and the aim of obtaining patient consent for surgery and increasing postoperative comfort. “Armed with all of this information, individuals can then decide for themselves whether face-down positioning is worth the effort.”Įhab N. Pollack, assistant professor of ophthalmology, Rush University Medical Center, Chicago. “Patients can be counseled that face-down positioning does not require lying in the prone position, but only that the head be tilted forward so that the eyes are looking down, such as in a position used for reading or texting,” said Dr. Recent: Is your city in the top 10 eye-healthy U.S. It is the responsibility of surgeons to provide patients the opportunity for their best chance at success, and with that in mind, retina surgeons should know that while macular hole surgery can be effective without face-down positioning, the highest success rates are achieved with some form of face-down positioning, said John S.
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