Yamashita Toshifumi, Sakamoto Taiji, Yamashita Takehiro, Sonoda Shozo, Yamakiri Keita, Otsuka Hiroki, Hisatomi Toshio, Imaki Hiroyuki, Ishibashi Tatsuro, Dugel Pravin U
*Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; †Department of Ophthalmology, Kyushu University School of Medicine, Fukuoka, Japan; ‡Department of Ophthalmology, Beppu Medical Center, Oita, Japan; and §Retinal Consultants of Arizona and Spectra Eye Institute, Phoenix, Arizona.
Retina. 2014 Jul;34(7):1367-75. doi: 10.1097/IAE.0000000000000087.
To evaluate the individualized, optical coherence tomography-guided facedown posturing after macular hole (MH) surgery in minimizing the burden and maximizing outcome.
A retrospective comparative study. One hundred and seven consecutive eyes with an MH (<500 μm) received vitrectomy and gas tamponade. After surgery, optical coherence tomography examination was performed from 6 hours to postoperative Day 2. In Group A, with a pro re nata posturing protocol, the duration of facedown posturing was determined from the optical coherence tomography findings. Group A was subdivided as follows: Group A1, facedown posturing required postoperatively and Group A2, no posturing required. When MH closure was confirmed, facedown posturing (if any) was discontinued. If the MH did not close, additional posturing was advised. Group B was the control group, consisted of 42 consecutive eyes with traditional 7 days of posturing.
After a single surgery, Group A had the MH closure rate of 96.2%, 95.8% in Group A1 and 97.1% in Group A2, whereas Group B had the MH closure rate of 95.2%. The average posturing period was 42 hours for Group A, 57 hours for Group A1 and 10 hours for Group A2 (P < 0.001). The MH size was correlated significantly with the closure time (R = 0.47, P = 0.005, Spearman correlation coefficient).
A pro re nata posturing protocol achieves a high MH closure rate with a significant reduction of posturing time especially for pseudophakic eyes.
评估黄斑裂孔（MH）手术后个体化的光学相干断层扫描引导下的俯卧位姿势，以尽量减轻负担并最大化手术效果。
一项回顾性对照研究。107只连续的MH（<500μm）患眼接受了玻璃体切除术和气液填充。术后6小时至术后第2天进行光学相干断层扫描检查。A组采用按需姿势方案，根据光学相干断层扫描结果确定俯卧位姿势的持续时间。A组再细分为：A1组，术后需要俯卧位姿势；A2组，不需要姿势。当确认MH闭合时，停止俯卧位姿势（如有）。如果MH未闭合，则建议进一步姿势。B组为对照组，由连续42只采用传统7天姿势的患眼组成。
单次手术后，A组的MH闭合率为96.2%，A1组为95.8%，A2组为97.1%，而B组的MH闭合率为95.2%。A组的平均姿势时间为42小时，A1组为57小时，A2组为10小时（P<0.001）。MH大小与闭合时间显著相关（R=0.47，P=0.005，Spearman相关系数）。
按需姿势方案可实现较高的MH闭合率，并显著减少姿势时间，尤其是对于人工晶状体眼。
