Pars plana vitrectomy (PPV) with gas tamponade can be considered a first-line treatment for patients with a rhegmatogenous retinal detachment.1,2 Researchers are now helping to fine-tune these patients’ experiences by showing that positioning patients on their sides gives better contact between the gas bubble and the inferior and anterior retina compared with a prone position.3 The position helps by providing better contact between the tamponade and the inferior retina, the investigators said in their paper.3
The study looked at MRI images of three patients undergoing the procedure (performed by the same surgeon).3 The day following the surgery, doctors measured the volume of intraocular gas and took four orbital MRI scans, each in different head positions: face-up (supine), face down (prone on a massage pillow), flat on the right side and flat on the left side.3 They found that the gas bubble and residual vitreous fluid showed a rapid shift when the patient's head position changed.3 The MRI images demonstrated that with both 70% gas fill and 95% gas fill, lying on the side position can give better support to the inferior retina than lying face-down.
Researchers say these images demonstrate the importance of accurate head positioning since a slight change can result in inadequate contact between the anterior inferior retina and the gas bubble.3
Earlier research compared the prone position with the supine position for this same patient population and found that the supine position may provide better tamponade gas coverage for breaks anterior to the equator than the prone position, although they stressed that potential postoperative complications caused by the supine position require careful attention.2
1. Ho J, Liou S, Tsai C, et al. Trends and outcomes of treatment for primary rhegmatogenous retinal detachment: a 9-year nationwide population-based study. Eye (Lond). 2009;23(3):669-75.
2. Gozawa M, Kanamoto M, Ishida S, et al. Evaluation of intraocular gas using magnetic resonance imaging after pars plana vitrectomy with gas tamponade for rhegmatogenous retinal detachment. Sci Reports. 2020;10:521.
3. Hostovsky A, Mandelcorn M, Mandelcorn E. Orbital MRI demonstrates better contact between the gas and the anterior inferior retina in side compared with face-down position. Ophthalmol. April 10, 2020. [Epub ahead of print].