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

Abstract

AIM: To evaluate the safety and efficacy of a minimally restricted face-down postoperative positioning following pars plana vitrectomy (PPV) with gas tamponade for primary rhegmatogenous retinal detachment (RRD). METHODS: Patients with primary RRD treated with PPV and gas tamponade and followed up for at least 6mo were selected for the study. All phakic eyes underwent simultaneous cataract surgery. The patients were required to be in a postoperative position that prevented downward flow of retinal tears. Patients with macular detachment were positioned face-down for only a couple of hours. The patients were assessed for preoperative and postoperative best-corrected visual acuity (BCVA), anatomical retinal reattachment rate, and postoperative complications. RESULTS: In total, 40 eyes of 39 patients with primary RRD were included in the study. A single tear was present in 30 eyes (75.0%), multiple retinal tears were present in nine eyes (22.5%), and oral dialysis was present in one eye (2.5%). The anatomical success rate was 90.0% (36 cases) after the primary surgery, and the final anatomical success rate was 100%. The BCVA improved significantly (P<0.001) from 0.75 logarithm angle of resolution (logMAR) preoperatively to 0.12 logMAR at the final visit. Postoperative complications included intraocular pressure elevation (≥25 mm Hg) in 11 patients (27.5%), fibrin formation in two patients (5.0%), pupillary capture of the intraocular lens in two patients (5.0%), and posterior synechia in one patient (2.5%). CONCLUSION: A minimally restricted face-down and flexible postoperative positioning after PPV and gas tamponade for primary RRD is effective and safe.

Expression levels of ROS and Atg proteins in the vitreous in rhegmatogenous retinal detachment

“…Patients' demographics data are summarized in Table 1. Patients with previous vitreoretinal surgery history, penetrating injury, uveitis, aphakia, age-related macular degeneration, diabetic retinopathy, or uncontrolled glaucoma were excluded [15][16] . After eye anesthesia, standard 23-G vitrectomy was performed through the flat part of ciliary body, the perfusion catheter was closed, and the vitreous in the central axis was excised.…”

Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment With No Postoperative Positioning

“…The single-surgery anatomic success rates for rhegmatogenous retinal detachment (RRD) repair using standard treatment methods have historically been over 90%. [1][2][3][4][5][6][7][8][9] Primary pars plana vitrectomy (PPV) with endolaser application and postoperative intraocular gas tamponade has continued to increase in popularity as the preferred treatment for uncomplicated RRD because of excellent single-surgery anatomic success rates and decreased patient discomfort. [1][2][3][4][5]10 Although such studies sought to elucidate the efficacy of primary PPV in the setting of RRD, there is less discussion on how postoperative prone positioning, especially the lack thereof, affects single-surgery anatomic success rates and visual outcomes for RRD patients in the modern microincision vitrectomy surgery (MIVS) era.…”

“…1,11 Since then, MIVS has evolved into the most common surgical intervention for RRD repair with the addition of endolaser application and intraocular gas tamponade (eg, 20% sulfur hexafluoride [SF 6 ]; 14% perfluoropropane [C 3 F 8 ]) with strict postoperative face-down positioning. [1][2][3][4][5][6][7][8]10 These adaptations have improved the rate of successful primary vitrectomy for RRD to approximately 90%, [1][2][3][4]8,10 with facedown positioning lasting between 7 days and 14 days. 1,3,4 Still, maintaining face-down positioning is a major complaint of patients having vitreoretinal surgery and is associated with poor patient compliance.…”

“…1,3,4 Still, maintaining face-down positioning is a major complaint of patients having vitreoretinal surgery and is associated with poor patient compliance. [3][4][5]12,13 Therefore, the evolution in vitreoretinal surgery requires updates on using positioning of a shorter duration while preserving exceptionally high surgical success rates.…”

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

“…M aintaining a specific head position during the postoperative period after pars plana vitrectomy (PPV) is usually recommended following retinal surgical procedures, such as repair of rhegmatogenous retinal detachment (RD) and full-thickness macular hole. 1,2 Although there is no consensus regarding the necessity of maintaining face-down position, 3 a survey of retinal specialists in 2020 indicated that 86.7% of surgeons in the United States instruct their patients to position face down for more than one day after macular hole surgery. 4 Prior work has demonstrated that after macula-involving RD repair, face-down positioning is associated with a reduction in the rate and amplitude of postoperative retinal displacement and reduction in binocular diplopia.…”