Comparing Postoperative Effect Of Face-down Position At Different Time In Idiopathic Macular Hole

Objective:To compare the postoperative effect of face-down position at different time in idiopathic macular hole,it provides a clinical basis for the treatment of idiopathic macular hole and helps to select the right time of face-down position after postoperative in idiopathic macular hole.Methods:We evaluated 40 patients(40 eyes)with idiopathic macular hole who were followed up for more than 6 months in Yanbian University Hospital from January 2016 to July 2018.According to the time of treatment divided into two groups,group A(after vitrectomy and internal limiting membrane peeled only fluid air exchanged,face-down position for 3 days)20 cases(20 eyes),)including 14 females(14 eyes)and 6 males(6 eyes).Group B(after vitrectomy and internal limiting membrane peeled only fluid air exchanged,face-down position for 7 days)20 cases(20 eyes),including 15 females(15 eyes)and 5 males(5 eyes).To compare the effects of hypertension,diabetes on the rate of macular hole closure.At the same time,the size of preoperative macular hole,the best corrected visual acuity of preoperative and postoperative,the mean intraocular pressure of preoperative and postoperative and the rate of macular hole closure after 6 months were compared.Results:1.There were 8 patients with hypertension in group A and 9 patients with hypertension in group B.The presence or absence of hypertension had no significant on macular hole closure rate(χ2=1.046,P=0.306;χ2=0.022,P=0.881).There were 4 patients with diabetes in group A and 2 patients with diabetes in group B.The presence or absence of diabetes had no significant on macular hole closure rate(x2=0.078,P=0.780;χ2=0.247,P=0.619).2.The mean macular hole size was 406.100±99.755μm in group A and 380.750±125.970μm in group B.There was no significant difference between the two groups(t=0.706,P=0.485)3.The best corrected visual acuity of preoperative patients(log MAR)in group A was 0.800±0.258,and that in group B was 0.745±0.254.There was no significant difference between the two groups(t=0.680:P=0.449).The best corrected visual acuity of postoperative patients(log MAR)was 0.555±0.219 at 6 months in group A,and that in group B was 0.61010.236.There was no significant difference between the two groups(t=-0.764,P=0.449).4.The average intraocular pressure of the day before surgery、the first day after surgery、the third day after surgery、the seventh day after surgery、the day of one month after surgery、the day of six months after surgery were no significant differences in the group A and group B(t=-0.434,P=0.667、t=1.824,P=0.077、t=-1.088,P=0.284、t=0.226,P=0.822、t=-0.862,P=0.394、t=0.355,P=0.725).5.At 6 months after surgery,the macular hole closure rate was 85%in group A and 95%in group B.There was no significant difference between in the group A and group B(χ2=0.229,P=0.633).Conclusion:1.There is no significant difference in postoperative effect between the two groups who have vitrectomy and peel internal limiting membrane,only fluid air exchange and adopt face-down position for 3 days compared vitrectomy and peel internal limiting membrane,gas tamponade after fluid air exchange and adopt face-down position for 7 days in patients with idiopathic macular hole.2.This surgical method is considered helpful for easing discomfort caused by a face-down position after the macular hole surgery.