The role of face-down positioning in full-thickness macular hole treated with inverted internal limiting membrane flap technique

Post-operative face-down positioning (FDP) after air– gas exchange is considered a critical step in the surgical management of full-thickness macular hole (FTMH). FDP is thought to improve the contact between the gas bubble and FTMH, thus maximizing the hole closure rate. However, FDP may be challenging for the elderly and patients with comorbidities, for whom there is a high risk of post-operative complications, in- cluding skin breakdown, pulmonary embolism, ulnar nerve neuropathy and muscle atrophy. Furthermore, the importance of post-operative FDP for a favourable outcome of FTMH surgery is still controversial, since published data on this topic derive from heterogeneous studies with different surgical approaches, making it dif- ficult to draw solid conclusions. Recently, inner limiting membrane (ILM) flap techniques for FTMH surgery has become increasingly popular and showed high rates of FTMH closure. We therefore assessed whether post- operative FDP may improve the anatomical and func- tional outcome in FTMH eyes treated with pars plana vitrectomy (PPV) with inverted ILM flap technique.