As reported by Japanese surgeons [Yamashita, et al. Retina. 2014;34(7):1367-1375], Optical coherence tomography can monitor the status of the macular hole and determine the need to continue prone positioning, but their use of this approach involved daily follow-up.
“Most macular holes close in 24 to 48 hours, and in this study, a closure rate of 96.2% was achieved with a mean prone positioning duration of 42 hours,” Dr. Thompson said. “However, there are some macular holes that can take seven days to close.”
Results of a Cochrane review of three randomized, controlled trials evaluating prone positioning support its consideration in eyes with large macular holes [Cochrane Database of Systematic Reviews 2001, Issue 12. Art no.: CD008228]. The analyses showed prone positioning had no significant benefit overall, but it was associated with a higher closure rate for holes >400 µm.
Dr. Thompson also noted that vitrectomy is more cost-effective than ocriplasmin (Jetrea, ThromboGenics) for treating macular holes, and the reason relates to the high cost of the pharmacologic agent. A cost benefit analysis comparing the two techniques calculated that the cost per quality-adjusted life year ranged from $5,444 to $7,442 for vitrectomy and from $8,159 to $10,244 for ocriplasmin [Chang JS, Smiddy WE. Ophthalmology. 2014;121(9):1720-1726].