Topical medication interferes with face-down positioning after macular hole surgery

Purpose: To investigate whether different procedures of topical medication interfere with postoperative face-down positioning and thereby influence the anatomical success rate of macular hole surgery. Methods: A total of 39 consecutive eyes with macular holes were operated with vitrectomy and fluid-gas exchange, followed by face-down positioning for 1 week. Postoperatively, the procedures for topical medication differed between two consecutive groups of patients. In the first group (16 patients), a conventional postoperative regimen of topical antibiotics and steroids was administered as eye drops six times daily. In the second group (23 patients), topical medication was administered as ointments once daily, while the patients kept their heads straight forwards and looked slightly downwards. Results: The macular hole closed successfully in 10 (62.5%) of the 16 eyes in the eye drop group, and in 21 (91.3%) of the 23 eyes in the ointment group (p < 0.05). Conclusion: The present study indicates that frequent postoperative administration of eye drops reduces the success rate of macular hole surgery. To prevent patients from looking upwards during the instillation of topical antibiotics and steroids, the use of ointments is recommended.