Adherence to face-down and non-supine positioning after macular hole surgery

Abstract

BackgroundThis study aimed to investigate patient adherence to face-down positioning (FDP) and non-supine positioning (NSP) following vitrectomy with gas tamponade for treating macular holes (MHs).MethodsNursing records of 92 patients who underwent vitrectomy with gas tamponade for small-diameter (diameter < 400 μm) MHs during April 2016–June 2017 were examined. Forty-seven and 45 patients were instructed to maintain FDP and NSP (FDP and NSP groups), respectively. Patient adherence was evaluated seven times a day for 3 days, and the adherence rate was calculated.ResultsThe mean adherence rate was significantly higher in the NSP group (99.3% ± 2.7%) than in the FDP group (93.7% ± 13.3%; P < 0.001, Mann–Whitney U test). Forty-one patients (91.1%) in the NSP group had an adherence rate of 100%, which was significantly higher than that in the 24 patients in the FDP group (51.1%; P < 0.001, chi-squared test). No statistically significant difference was observed between the patients in the two groups regarding sex, age, MH diameter, and pre- and postoperative visual acuities. MH closure was achieved in all patients.ConclusionsAlmost half of the patients in the FDP group did not obtain 100% adherence rate, suggesting that patient adherence was largely compromised. Patient adherence was better in the NSP group as patient compliance to NSP was better, however, 8.9% of patients were found in face-up positioning at least once. Incompleteness of patient adherence was common, although to differing degrees.

Macular hole closure with minimal or no posturing after macular hole surgery

“…One is the gas tamponade for which some authors have suggested additional gas injection in case of non-closure at first attempt 16 . In addition to that Emi Morimoto showed that 50% of the patients are non-compliant regarding face down posturing 17 . Some studies have indicated the non-supine posturing was equally good for macular hole closure 18 .…”

Quantifying Head Position Following Vitrectomy Using a 3-Dimensional Position Sensor Embedded in a Novel Ophthalmic Shield: A Pilot Study

“…In addition to larger numbers, a longer follow-up period is needed to correlate factors with clinical outcomes. 9 Despite its limitations, this pilot study presents some novel angles including the use of a compact wireless position sensor in an ophthalmic shield platform that obviates the use of more cumbersome or potentially uncomfortable head gear or bands. This device showed it could reliably record the head position every 5 minutes and without any interruption, which is useful if any live sensory feedback is going to be used in the future.…”

“…In addition to larger numbers, a longer follow-up period is needed to correlate factors with clinical outcomes. 9…”

“…3,6 There have been some efforts to monitor postoperative head positioning and provide feedback to increase patient compliance, ranging from direct observation by nurses in an inpatient setting to constant monitoring by small wireless devices. [7][8][9] For instance, Velez-Montoya et al 10 described using an elastic headband with an embedded monitoring device to measure the head position after pneumatic retinopexy and concluded that it is difficult to maintain a sustained lateral flexion of the neck for more than five consecutive hours. Moreover, Brodie et al 8 conducted a short pilot study involving a different wireless sensor also embedded in a headband on healthy volunteers for 3 hours and found that it could improve positioning compliance by just over 40% in about half of the participants.…”

Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade

“…Silicone oil tamponade is employed for those cases. Furthermore, in rare cases, the face-down position can also cause systemic complications such as pulmonary embolism, thrombophlebitis, and ulnar nerve palsy [5][6][7] . To overcome these problems, recent studies have reported that a strict face-down position may not be necessary [8][9][10][11] .…”