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.
Highlights
Retinal detachment (RD) is most often the result of the retina becoming thinner and more brittle with age and pulling away from the underlying blood vessels; it can be caused by a direct injury to the eye, but this is less common
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
In particular metamorphopsia may result from unintentional retinal displacement which may be eleganty disclosed by fundus autofluorescence [6,7]
Summary
Retinal detachment (RD) is most often the result of the retina becoming thinner and more brittle with age and pulling away from the underlying blood vessels; it can be caused by a direct injury to the eye, but this is less common. Oxidative stress and elevated ROS (Reactive oxygen species) has been implicated in the mechanism of senescence and aging too They are involved in many diseases such cancer, diabetes, neurodegenerative, cardiovascular and other type of pathologies [3,4]. The displacement may lead to postoperative horizontal and vertical strabismus and to metamorphopsia, which may both impair the ability to perform the daily-life activity and prolong the recovery time after surgery This is especially true for elderly people who can be affected by other ocular and systemic co-morbidities. The aim of this study was to evaluate the feasibility, efficacy and safety of strict prone position taken for 2 hours after operation in preventing the occurrence of retinal displacement in a elderly group of patients undergone vitrectomy and gas for RD
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