Our Summary

This research paper is about a study that compared different ways of positioning patients after they’ve had a specific type of eye surgery (pars plana vitrectomy or PPV) for a particular type of retinal detachment (rhegmatogenous retinal detachment or RRD).

The authors looked at medical literature published from 2000 to February 2022, and ended up including seven studies involving 703 eyes in their analysis. They found that the final vision outcome didn’t differ between different positioning regimens after the surgery. However, there were differences in the success rate of the surgery and in the types of complications experienced by patients.

Patients who were positioned in ways other than lying face down (prone) had a higher success rate for the surgery. But there were trade-offs. For instance, lying face down led to a higher risk of neck pain and elevated pressure within the eye, while a positioning method called “support-the-break” had a greater risk of the retina shifting or folding, and of double vision.

The researchers also found that lying face down immediately after surgery was better than delaying this positioning, in terms of reducing the risk of the retina shifting.

In simple terms, the study suggests that how a patient is positioned after this specific type of eye surgery can affect the success of the surgery and the risk of complications. But there’s a balance to be struck between different risks, and immediate face-down positioning seems to be beneficial.

FAQs

  1. What is the most effective postoperative positioning regimen after pars plana vitrectomy (PPV) for retinal detachment?
  2. Are there differences in the risk of complications between prone and alternative posturing regimens?
  3. How does immediate prone positioning affect the risk of retinal displacement after surgery?

Doctor’s Tip

A doctor might tell a patient undergoing retinal detachment surgery to follow their specific postoperative positioning regimen carefully to optimize the chances of successful reattachment and minimize complications. It is important to discuss any concerns or discomfort with the medical team to ensure the best possible outcome.

Suitable For

Patients who are typically recommended retinal detachment surgery include those with rhegmatogenous retinal detachment, particularly those with inferior breaks. The decision to undergo surgery is based on factors such as the location and severity of the detachment, the patient’s overall health and visual acuity, and the potential risks and benefits of the procedure. It is important for patients to discuss their individual case with their ophthalmologist to determine the best course of action for their specific situation.

Timeline

  • Before retinal detachment surgery: The patient may experience symptoms such as sudden flashes of light, floaters in the vision, or a shadow or curtain over part of the visual field. They will undergo a comprehensive eye examination to confirm the diagnosis of retinal detachment.

  • Day of retinal detachment surgery: The patient will undergo pars plana vitrectomy (PPV) to repair the detached retina. The surgery typically lasts 1-2 hours and is performed under local or general anesthesia.

  • Immediately after retinal detachment surgery: The patient may experience mild discomfort, redness, or swelling in the eye. They will be instructed on postoperative positioning, which may involve maintaining a specific head or body position to aid in the healing process.

  • Weeks to months after retinal detachment surgery: The patient will have follow-up appointments to monitor the healing of the retina and assess visual acuity. Vision may gradually improve over time, but it may take several months for full recovery.

  • Long-term after retinal detachment surgery: The patient may be advised to avoid activities that put strain on the eyes, such as heavy lifting or high-impact sports. Regular eye exams will be recommended to monitor for any signs of recurrent detachment or other complications.

What to Ask Your Doctor

  1. What postoperative posturing regimen do you recommend for my specific case of retinal detachment?
  2. What are the potential risks and benefits of the recommended posturing regimen?
  3. How long will I need to maintain the posturing regimen after surgery?
  4. Are there any specific instructions or tips you can provide to help me with the posturing regimen?
  5. What is the likelihood of successful reattachment with the recommended posturing regimen?
  6. Are there any factors that may affect the effectiveness of the posturing regimen in my case?
  7. What should I do if I experience any discomfort or complications while maintaining the posturing regimen?
  8. How often will I need to follow up with you after the surgery to monitor my progress?
  9. Are there any alternative posturing regimens that could be considered for my case?
  10. What are the potential long-term effects of the posturing regimen on my vision and overall eye health?

Reference

Authors: Sverdlichenko I, Lim M, Popovic MM, Pimentel MC, Kertes PJ, Muni RH. Journal: Surv Ophthalmol. 2023 Jan-Feb;68(1):113-125. doi: 10.1016/j.survophthal.2022.09.002. Epub 2022 Sep 16. PMID: 36116526