Our Summary
This research study aimed to compare the results of a specific eye surgery, called pars plana vitrectomy (PPV), in patients who were positioned face-down (prone position) after the operation and those who were not. The surgery was performed to treat a condition known as rhegmatogenous retinal detachment (RRD), which is when the retina (part of the eye that senses light and sends images to the brain) detaches from the back of the eye.
The study involved 142 patients who underwent the PPV procedure. After the operation, some were asked to maintain a face-down position while others were not. The researchers followed up with the patients for over three months to assess their vision and see if the retina reattached successfully.
The results showed that the group who were not instructed to maintain the face-down position after the surgery had a higher rate of successful retinal reattachment (96.1%) compared to the group that did (83.1%). Furthermore, in cases where the retina detached at the bottom of the eye, not maintaining a face-down position after surgery resulted in a significantly higher reattachment rate (94.7%) compared to maintaining a face-down position (60%).
However, the researchers found no significant difference in the reattachment rates in cases where the retina detached from areas other than the bottom of the eye. In terms of vision, there was no notable difference between the two groups three months after the operation.
The study concluded that not maintaining a face-down position after PPV surgery can lead to a higher success rate for retinal reattachment, especially if the detachment occurred at the bottom of the eye. The results also suggest that lying on one’s back or side after surgery might be beneficial if a specific part of the retina is treated during the surgery.
FAQs
- What is the purpose of the study on pars plana vitrectomy (PPV) for treating rhegmatogenous retinal detachments (RRDs)?
- What were the main findings of the study comparing PPV outcomes with and without postoperative prone positioning?
- What are the benefits of PPV without postoperative prone positioning in managing RRDs associated with inferior retinal breaks?
Doctor’s Tip
A helpful tip a doctor might tell a patient about vitrectomy is to follow postoperative positioning instructions carefully. In some cases, maintaining a prone position after surgery may be beneficial for achieving a higher reattachment rate, especially for eyes with inferior retinal breaks. Additionally, if the internal limiting membrane (ILM) is peeled during surgery, postoperative supine and lateral positioning may be recommended to help manage the retinal detachment effectively. It is important to adhere to these positioning instructions to optimize the outcomes of the vitrectomy procedure.
Suitable For
Patients with rhegmatogenous retinal detachments (RRDs), particularly those with inferior retinal breaks, may be recommended vitrectomy with postoperative supine and lateral positioning to improve reattachment rates. In cases where the internal limiting membrane (ILM) is peeled during the procedure, postoperative prone positioning may not be necessary. Additionally, patients who develop epiretinal membranes (ERMs) postoperatively may benefit from ILM peeling during vitrectomy. Overall, vitrectomy may be recommended for patients with RRDs to improve anatomical and functional outcomes.
Timeline
Before vitrectomy: The patient undergoes a comprehensive eye examination to diagnose the retinal detachment. The patient may experience symptoms such as flashes of light, floaters, or a sudden decrease in vision. The decision is made to undergo pars plana vitrectomy (PPV) surgery with gas tamponade.
During vitrectomy: The patient undergoes PPV surgery with 20% sulfur hexafluoride gas tamponade. The surgery typically lasts a few hours and involves removing the vitreous gel from the eye, repairing the retinal detachment, and placing a gas bubble to help the retina heal properly.
After vitrectomy: The patient is divided into two groups, one with postoperative prone positioning and one without. The initial reattachment rates are compared between the two groups, with a higher reattachment rate seen in the group without prone positioning, especially in eyes with inferior retinal breaks. The best-corrected visual acuity (BCVA) is evaluated at the 3-month postoperative visit, and no significant difference is found between the two groups. Postoperative complications such as epiretinal membranes are noted in some eyes, particularly in those where the internal limiting membrane (ILM) was not peeled during PPV.
Overall, PPV without postoperative prone positioning may be associated with a higher reattachment rate in eyes with rhegmatogenous retinal detachments, especially those with inferior retinal breaks. PPV with postoperative supine and lateral positioning may be beneficial for managing retinal detachments associated with inferior retinal breaks if ILM peeling is performed during surgery.
What to Ask Your Doctor
- What is the success rate of vitrectomy for treating my specific condition (e.g. rhegmatogenous retinal detachment)?
- Will postoperative prone positioning be necessary for my recovery? What are the potential benefits and risks of following this positioning?
- What are the potential complications or side effects of vitrectomy surgery?
- How long is the typical recovery period after vitrectomy surgery?
- Will I need any additional procedures or treatments after the vitrectomy?
- How soon after the surgery will I be able to resume normal activities?
- What are the potential long-term effects of vitrectomy on my vision?
- Are there any specific precautions or lifestyle changes I should follow after the surgery?
Reference
Authors: Shiraki N, Sakimoto S, Sakaguchi H, Nishida K, Nishida K, Kamei M. Journal: PLoS One. 2018 Jan 26;13(1):e0191531. doi: 10.1371/journal.pone.0191531. eCollection 2018. PMID: 29373582