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Roberto dell'Omo, Mariluccia Cassetta, Mariaelena Filippelli, Dario Giorgio, Rocco Calo, Roberto Di Iorio, Antonio De Lena, Ciro Costagliola; Short-time prone posturing reduces the rate of retinal displacement after vitrectomy for retinal detachment.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2310.
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To demonstrate the efficacy of short-time prone positioning in preventing the rate of unintentional retinal displacement in patients operated on with vitrectomy for rhegmatogenos retinal detachment (RRD)
Prospective interventional case series. Fifty-six eyes of 56 patients with RRD underwent 23 or 25 vitrectomy and tamponade with 20% sulfur hexafluoride (SF6) or silicone oil (SO) 1000 csk by a single surgeon. Indipendently from the location of the breaks the patients maintained a strict face-down posturing for 2 hours after operation. Fundus autofluorescence (FAF) images were recorded at 1 month postoperatively to detect displacement of the retina, as revealed by the presence of retinal vessel printings (RVPs) , i.e. lines of increased autofluorescence parallel to retinal vessels. Both a confocal scanning laser ophthalmoscope ( Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg, Germany) and a fundus camera (Topcon NW8F, Topcon, Tokyo, Japan) were used in all cases to record the images.
The mean age of these 56 patients was 56.7 ± 10.7 years ( range 24-79 years). Of the 56 eyes, retinal detachment involved 4 quadrants in 15 eyes, 3 quadrants in 10 eyes, 2 quadrants in 25 eyes, and 1 quadrant in 6 eyes (mean± SD, 2.6 ± 1.0). Macula-involvement was observed in 45 eyes. After complete reattachment of the retina, FAF photography demonstrated RVPs in 16 eyes ( 28.5 %). Of these 15 had received SF6 and 1 had received SO as tamponade. RVPs were found above (downward shifting) in 10 cases , below (upward shifting) in 1 case and laterally (lateral shifting) in 5 cases, to the retinal vessels. No difference in detecting the RVPs between the two instruments was found. None of the eyes with macula-on detachment showed RVPs. The extent of retinal detachment (P < 0.028) and the macular status (on or off) were significantly associated (P < 0.021) with postoperative displacement of the retina.
Short-time prone posturing is effective in reducing the rate of unintentional retinal displacement after vitrectomy for RRD. Both the confocal laser ophthalmoscope and the fundus camera are equally sensible in detecting the RVPs.
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