Researchers compared clinical outcomes in eyes with macular hole managed by either facedown (FD) or no-FD (nFD) postoperative positioning protocols, as part of a prospective, randomized cohort study.

Eighty eyes of 80 consecutive individuals with MH that underwent vitrectomy surgery with internal limiting membrane peeling and gas tamponade were included. Forty eyes of 40 individuals kept in FD position for three days after surgery were assigned to the FD group, and 40 eyes of 40 individuals with nFD positioning were assigned to the nFD group. Researchers examined macular holes with swept-source optical coherence tomography images at one day, two days, three days, two weeks, one month and three months after surgery. They compared the MH closure rate and change of best-corrected visual acuity. Below are some of the findings:

• At postoperative day one, MHs were closed in 24 of 32 eyes (with clear OCT images) (75 percent) in the FD group, and 23 of 30 eyes (with clear OCT images) (77 percent) in the nFD group (p=0.97).
• At postoperative day two, MH closures were confirmed in 32 of 36 eyes (88.9 percent) in the FD group and in 31 of 33 eyes (94 percent) in the nFD group (p=0.84); results were unchanged at day three.
• At two weeks post-surgery, clear OCT images were acquired from all eyes in both groups, and MH closures were confirmed in 36 of 40 eyes (90 percent) in the FD group and in 37 of 40 (92.5 percent) eyes in the nFD group (p=0.91).
• Macular hole closures weren’t achieved in eyes kept open by day three post-surgery, and no eyes with confirmed MH closures by day three had reopenings by three months.
• The distribution of macular configurations at three months wasn’t significantly different between the two groups (p=0.96).
• Researchers found no differences in improvement in best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letters gain) between the two groups at one month (p=0.22) and three months (p=0.45).

Researchers found that the nFD protocol neither delayed MH closures nor decreased the final closure rate after vitrectomy surgery. As such, they suggested that using the prone position postoperatively seemed to be unnecessary for all MH repair procedures.

Investigators reported image artifacts due to retinal pigment epithelium hyperplasia overlying retinal pigment epithelial detachment in age-related macular degeneration, which can masquerade as neovascularization on optical coherence tomography angiography.

The hospital-based, retrospective and cross-sectional study included 22 eyes from 16 subjects with non-vascularized PED related to AMD. All subjects were examined by OCTA, spectral-domain OCT, fluorescein angiography and indocyanine green angiography. Investigators evaluated vascular flow signals on the outer retinal slab of en face OCTA and cross-sectional OCTA images, and their correspondence with RPE hyperplasia. Here are some of the investigators’ findings:

• Fifteen eyes (68.2 percent) showed VFS on both the outer retina slab of en face OCTA and cross-sectional OCTA, all corresponding with RPE hyperplasia overlying PED. Among them, 12 eyes with lump RPE hyperplasia outside the foveal avascular zone showed obvious VFS on the outer retina slab of OCTA, and three eyes with scattered RPE hyperplasia outside the FAZ showed VFS fragments.
• Four eyes had accompanied RPE hyperplasia inside the FAZ, and seven eyes without RPE hyperplasia overlying PED showed no corresponding VFS on the outer retina slab of OCTA.
• Investigators observed round, dark bands at the edge of PED in the outer retina slab on en face OCTA in 17 eyes (77.3 percent).

Investigators determined that RPE hyperplasia overlying PED in AMD could masquerade as neovascularization on OCTA. They suggested that this RPE hyperplasia-related image artifact should be considered when interpreting OCTA images to avoid misdiagnosis and unnecessary treatment.