The effect of different body positions after pars plana vitrectomy and inert gas filling for rhegmatogenous retinal detachment / 中华眼底病杂志

Objective:To compare and observe the curative effect of different body positions after pars plana vitrectomy (PPV) combined with inert gas filling for rhegmatogenous retinal detachment (RRD).Methods:A retrospective clinical study. From October 2019 to September 2021, 192 eyes of 192 RRD patients who were diagnosed and received PPV combined with inert gas filling in Qingdao Eye Hospital of Shandong First Medical University were included in the study. Best corrected visual acuity (BCVA), intraocular pressure, ultra-wide-angle fundus photography, optical coherence tomography, and B-mode ultrasonography were performed in all affected eyes. The BCVA examination was performed using a standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the post-operative position requirements, the affected eyes were divided into the face-down positioning group and the adjustable positioning group, with 97 eyes in 97 patients and 95 eyes in 95 patients, respectively. Age ( Z=0.804), course of disease ( Z=-0.490), eye type ( χ2=0.175), logMAR BCVA( Z=-0.895), intraocular pressure ( Z=0.178), lens status ( χ2=1.090), number of detached clocks ( Z=0.301) and macular involvement ( χ2=0.219), number of holes ( Z=-1.051) and number of lower holes ( χ2=0.619) were compared, there was no significant difference ( P>0.05). The gender composition ratio was compared, and the difference was statistically significant ( χ2=5.341, P<0.05). The follow-up time after surgery was more than 3 months. The retinal reattachment rate in one operation, the improvement of BCVA and the incidence of complications were observed. The independent sample Mann-Whitney test was used for the comparison of continuous variables between groups; the χ2 test was used for the comparison of categorical variables. Results:In the face-down positioning group and the adjustable positioning group, retinal reattachment in one operation was performed in 92 (94.8%, 92/97) and 89 (93.7%, 89/95) eyes, respectively; logMAR BCVA was 0.45±0.34, 0.41±0.21. There was no significant difference in the retinal reattachment rate in one operation ( χ2=0.120, P=0.729) and logMAR BCVA ( Z=-0.815, P=0.416) between the two groups. After surgery, the intraocular pressure increased in 11 (11.3%, 11/97) and 5 (5.3%, 5/95) eyes in the face-down positioning group and the adjustable positioning group, respectively; the secondary epimacular membrane was 2 (2.1%, 2/97), 3 (3.2%, 3/95) eyes. There was no significant difference in the incidence of elevated intraocular pressure and secondary epimacular membrane between the two groups after surgery ( χ2=2.320, 0.227; P=0.128, 0.634). Conclusion:It is safe and effective to adopt adjustable positioning after PPV combined with inert gas filling for RRD, which is equivalent to the effect of face-down positioning.

Silicone Oil with Short-Term Prone Position in Macular Hole Retinal Detachment Surgery in High Myopia

PURPOSE: To evaluate the result of vitrectomy with internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning in highly myopic patients with retinal detachment due to macular hole. METHODS: Eleven eyes of highly myopic patients with retinal detachment caused by macular hole were retrospectively reviewed. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade with short term (1-3 days) face-down positioning. Silicone oil was removed between 6 and 12 months postoperatively. Outcomes included best-corrected visual acuity, retinal reattachment rate, macular hole closure, and complications. RESULTS: The mean age of patients was 63.3 +/- 8.3 years. During the silicone oil period, all 11 eyes (100%) had complete retinal attachment. After silicone oil removal, retinal detachment recurred in 2 eyes (18.2%). Macular hole closure was observed in 8 eyes (72.7%). The best corrected visual acuity (log MAR) improved from 1.99 +/- 0.94 before surgery to 1.33 +/- 0.62 at final visit. CONCLUSIONS: Pars plana vitrectomy, internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning was effective in treating retinal detachment caused by macular hole in highly myopic eyes.

Ulnar Neuropathy as a Complication of Retinal Detachment Surgery

PURPOSE: To report a case of ulnar neuropathy as an extraocular complication following retinal detachment surgery and face-down positioning. CASE SUMMARY: A 65-year-old woman was referred to our hospital with decreased visual acuity in the left eye. Fundus examination revealed a rhegmatogenous retinal detachment not involving the macula in the left eye. A vitrectomy with scleral encircling and 18% SF6 gas tamponade was performed. The patient was instructed to assume a face-down position. After 5 days, the patient reported having paresthesia and numbness of the left 4th and 5th fingers. Neurologic exams were performed and the results indicated ulnar neuropathy. There was no improvement in the neurologic symptoms during the 6-month follow-up. CONCLUSIONS: Surgeons performing retinal surgery should caution their patients of ulnar neuropathy when face-down positioning is required. The patients should be instructed to minimize the time spent with their elbows flexed in a stationary position. Additionally, the pressure loaded on the bent elbow should be minimized.