Short-time prone posturing is well-tolerated and reduces the rate of unintentional retinal displacement in elderly patients operated on for retinal detachment

Abstract

PurposeTo evaluate the feasibility, efficacy and safety of strict prone posturing taken for 2 hours after operation in preventing the occurrence of unintentional retinal displacement in elderly patients operated on for retinal detachment (RD).MethodsTwenty patients aged 60 or more with diagnosis of macula-off RD were asked to keep a strict face-down posturing for 2 hours after vitrectomy and 20% sulfur hexafluoride tamponade. IOP was measured immediately before and after surgery and after the 2-hour posturing. A questionnaire was administered to each patient to evaluate the rate of discomfort experienced because of the face-down posturing. Unintentional displacement of the retina was assessed by evaluating the presence of retinal vessel printings on fundus autofluorescence images taken 4 weeks after operation.ResultsThe 2-hour posturing was generally well-tolerated. A mild neck pain was the most common reported symptom. Only a few patients experienced moderate breath shortness while posturing and none had to break the posturing because of respiratory problems. Intraocular pressure (IOP) measured before operation (11.7 ± 2.6 mmHg) was significantly different from IOP recorded at the end of surgery (18.9 ± 4.9 mmHg) and from IOP measured 2 hours after surgery (16.8 ± 4.7 mmHg, P<0.05, Friedman test). IOPs measured immediately and 2 hours after surgery did not differ significantly. Fundus autofluorescence imaging showed RVPs in 7 eyes.ConclusionsThis study shows that a 2-hour face-down posturing is effective in reducing the rate of retinal displacement in patients operated on for rhegmatogenous retinal detachment using vitrectomy and SF6 20%. A 2-hour face-down posturing is feasible for elderly patients and does not appear to cause unwanted, post-operative IOP raises.

Postretinal Detachment Retinal Displacement: How Best to Detect It?

“…While some of the variation may be due to surgical technique or any postoperative posturing advised, it is also possible that differences in detection rates result from different imaging systems. Studies that used FCs found an incidence of between 60 and 72% [1,2,4,5], whereas studies using a cSLO system found an incidence of 14-41% [3,7,8]. Differences between these 2 imaging modalities in detecting macula pathology have previously been reported [9,10], as has a difference in the gradability of the images due to signal to noise ratio [10].…”

Rate of Postoperative Autofluorescent Macular Shift with Expanding Gas Bubble Tamponade and No Prone Posture Ambulatory Care in Patients with Macula-Involved Retinal Detachment

“…Unintentional macula displacement or "macula shift" can complicate otherwise anatomically successful repair of macula-involved or macula-uninvolved retinal detachments (RD) [1][2][3][4][5][6][7][8][9].…”

“…Vitrectomy with standard subtotal volume isovolumetric gas tamponade has been reported to be associated with fundus autofluorescent (FAF) shift rates between 23 and 72% [1][2][3][4][5][6][7][8][9]. Most series contain patients with both maculainvolved and macula-uninvolved RD.…”

Optical coherence tomography evaluation of patients with macula‐off retinal detachment after different postoperative posturing: a randomized pilot study

“…In this study, a supine or prone postoperative positioning has been evaluated, with or without the use of PFCO, to detect whether these differences in the surgical procedure can cause any difference in the occurrence of retinal folds. The results showed that the presence of retinal folds was similar in all groups, so neither the possible use of PFCO nor the different postoperative positioning seems to play a role (Dell'Omo et al 2013). The immediate pressure on the retina caused by the PFCO use does not seem to affect the occurrence of the retinal folds, also because the PFCO usually is removed within minutes during surgery.…”