A Comparison of Face-Down Positioning and Adjustable Positioning After Pars Plana Vitrectomy for Macular Hole Retinal Detachment in High Myopia

Abstract

PurposeTo compare the anatomical and functional outcomes of macular hole retinal detachment (MHRD) in high myopia after pars plana vitrectomy (PPV) with face-down positioning and adjustable positioning.MethodsFifty-three eyes from 53 patients with MHRD were analyzed in this study. All patients received PPV with silicon oil for tamponade and then subdivided into 2 groups: 28 were included in a face-down positioning group and 25 were included in the adjustable positioning group. Patients were followed up for at least 6 months. The main outcome was the rate of anatomical macular hole (MH) closure and retinal reattachment. Secondary outcome measures were the best-corrected visual acuity and postoperative complications.ResultsThere was no significant difference in the rate of MH closure (53.6 vs. 72.0%, p = 0.167) and retinal reattachment (100 vs. 96%, p = 0.472) between the face-down group and adjustable group. Compared with the mean preoperative best-corrected visual acuity (BCVA), the mean postoperative BCVA at the 6-month follow-up improved significantly in both groups (p = 0, both). But there was no significant difference in the mean postoperative BCVA (p = 0.102) and mean BCVA improvement (p = 0.554) at 6 months after surgery between the two groups. There was no significant difference in the high intraocular pressure (IOP) after surgery between the two groups (53.6 vs. 44%, p = 0.487). There were no other complications that occurred during the follow-up.ConclusionAdjustable positioning after PPV with silicon oil tamponade for MHRD repair is effective and safe. Face-down positioning does not seem to be necessary for all patients with MHRD.

A Comparison of adjustable positioning and free positioning after pars plana vitrectomy for rhegmatogenous retinal detachment

“…Gradually, some studies have reported the e cacy of postoperative positioning which did not require face-down positioning after vitrectomy for RRD 1-4, 10,11 . Our team has also achieved high success rates with adjustable positioning in treatment for RRD 12 and macular hole retinal detachment 13 . Based on these studies, we compared adjustable and free postoperative positioning after PPV for RRD to demonstrate the safety and effectiveness of free positioning.…”

A Comparison of Adjustable Positioning and Free Positioning After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: A Prospective Randomized Controlled Study

“…Our team has also achieved high success rates in treatment for RRD 12 and macular hole retinal detachment through patients' postoperative adjustable positioning. 13 In this study, we compared the safety and efficiency between adjustable and free postoperative positioning after PPV for RRD.…”

Vitrectomy combined with lens capsule flap transplantation in the treatment of high myopia macular hole retinal detachment: study protocol for a prospective randomised controlled trial

“…The long axis reduces the extension of the retina, resulting in the relative shortening of the retina and subsequent retinal splitting and detachment. 12 …”

“…Possible mechanisms of HMMHRD include vitreoretinal traction caused by epiretinal membrane, residual vitreous cortex, inner limiting membrane (ILM) and retinal vascular system,9 which makes the vertical and tangential traction generated by the epiretinal membrane and ILM10 11 and further weakens the adhesion between retinal neuroepithelial layer and retinal pigment epithelium (RPE). The long axis reduces the extension of the retina, resulting in the relative shortening of the retina and subsequent retinal splitting and detachment 12…”

“…The long axis reduces the extension of the retina, resulting in the relative shortening of the retina and subsequent retinal splitting and detachment. 12 The key to the treatment of HMMHRD is to restore the normal anatomical structure of the macular region, improve the continuous traction state of the vitreous to the retina and induce retinal reattachment. The main surgical procedures include extrascleral surgery (scleral buckling, macular banding and posterior scleral reinforcement), intraocular surgery (vitrectomy) and combined intraocular and extraocular surgery.…”