Nonsupine Positioning after Macular Hole Surgery

Lindtjørn, Birger; Krohn, Jørgen; Austeng, Dordi; Varhaug, Pål; Basit, Samy; Helgesen, Ole Harald; Eide, Geir Egil; Forsaa, Vegard Asgeir

doi:10.1016/j.oret.2018.12.006

Cited by 14 publications

(6 citation statements)

References 22 publications

(22 reference statements)

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“…In contrast, 13.1% of United States retina surgeons in the 2018 ASRS PAT survey reported that they do not position their patients face-down following macular hole surgery. [ 6 ] In a recent prospective multicenter study, Lindtjørn, et al [ 35 ] reported a 99.5% MH closure rate with 3–5 days of postoperative nonsupine (but not face-down) positioning. The authors suggest that their results corroborate those of others who have found strict face-down positioning to be unnecessary in achieving successful outcomes.…”

Section: Discussionmentioning

confidence: 99%

Vitreoretinal Society of India practice pattern survey 2020: Surgical retina

Narayanan

Sheth

Weng

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To present the outcomes of the Vitreo-retinal Society of India (VRSI) Practice Pattern Survey 2020 in surgical retina. Methods: An online survey of members of VRSI was conducted in April 2020 regarding their practice patterns on varied medical and surgical retina topics concerning imaging and management approach. The results were evaluated by two independent experts in this field and compared with the evidence and other practice patterns in the world. Results: A total of 107 VRSI members participated in the online survey. Responses were obtained on management of wide-ranging surgical retina topics such as diabetic retinopathy, retinal detachments, Macular Hole, and Epiretinal membranes. Participants were also surveyed regarding their attitudes and perceptions about microscopes with the heads-up display system. Each of the survey question responses were then compared to contemporary literature, including evidence-based guidelines, randomized controlled trials, real-world evidence, and analogous international surveys. Comprehensive analysis related to this has been put forward in the article. Conclusion: This survey represents the contemporary practice patterns among vitreoretinal specialists in India. The survey results are vital for fellow practitioners to understand the “standard of care” practice in surgical retina. This will guide them to devise the best possible individualized treatment strategy for most favorable clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Vitreoretinal Society of India practice pattern survey 2020: Surgical retina

Narayanan

Sheth

Weng

et al. 2021

Indian Journal of Ophthalmology

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“…Lindtjørn et al strongly proposed that non-supine positioning provided excellent closure of idiopathic macular holes. He also suggested that complete gasfoveal contact without minor interruptions was not necessary for macular hole closure 13 . Contrary to that another researcher suggested that degree of gas fill had considerable effect on the results of hole closure 14 .…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Purpose: To find the success rate of idiopathic and traumatic Macular hole (MH) with minimal/ no posturing after Macular Hole (MH) surgery. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology clinic, Shifa International Hospital Islamabad from July 2017 to December 2018. Material and Methods: Nineteen eyes of 19 patients with either idiopathic or traumatic MH were included in the study. All the patients with decreased vision due to any other cause or previous failed MH surgery were excluded. Their preoperative swept source OCT scans were done and MH was categorized according to size of MH. 27 gauge 3 ports pars plana vitrectomy, inner limiting membrane peel and gas (Hexafluoroethane) tamponade was performed in all the patients. No posturing was advised for small MH while minimal prone positioning was advised for medium and large sized MH. Results: All the patients had closed MH at post-operative day 1 except one patient who showed decrease in size of hole after surgery. There was significant improvement in vision in all patients from mean preoperative visual acuity of 0.8 logarithm of minimum angle of resolution (Range 0.3 to 2.0) to mean post-operative visual acuity of 0.3 logarithm of minimum angle of resolution (Range 0.1 to 0.5). On an average 4 lines improvement in visual acuity occurred. Conclusion: This study confirms MH closure within 24 hours on the basis of swept source OCT. Prone positioning does not appear to affect closure of small MH. For medium and large sized MH, minimal posturing is needed.

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“…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] . PPV with complete drainage of subretinal fluid (SRF) and no face-down positioning in the postoperative period leads to a high anatomical retinal reattachment rate in the primary pseudophakic RRD [4,[8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…To overcome these problems, recent studies have reported that a strict face-down position may not be necessary [8][9][10][11] . PPV with complete drainage of subretinal fluid (SRF) and no face-down positioning in the postoperative period leads to a high anatomical retinal reattachment rate in the primary pseudophakic RRD [4,[8][9] . Chen et al [10] reported that for RRD repair, the primary retinal reattachment rate of PPV with gas tamponade and a flexible postoperative position (alternative upright or lateral recumbent) was the same as that with a strict face-down position.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Nonsupine Positioning after Macular Hole Surgery

Abstract: To evaluate the postoperative closure rate of full-thickness macular holes (MH) after nonsupine positioning, which means that the patients avoid upward gaze and a supine sleeping position, and to investigate the correlation between postoperative positioning compliance and closure rate.

Cited by 14 publications

References 22 publications

Vitreoretinal Society of India practice pattern survey 2020: Surgical retina

Vitreoretinal Society of India practice pattern survey 2020: Surgical retina

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

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

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