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Henrik F. Schaefer, Pankaj Singh, Michael Koss, Koch Frank; Significant Compliance Improvement For Patients Lying Postoperatively In "Face-down-position" After Vitrectomy And Gas Tamponade. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5797.
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The positioning of a patient after pars plana vitrectomy (ppV) with gas tamponade has been discussed controversially since the beginning of macular surgery. In most of the study designs "face-down-positioning" (fdp) is advised.However it is not clearly described how the "fdp" was achieved. In most of the studies it is not shown if the patients had suitable aids and how long they used them.
Our pilot study was prospective, controlled and randomized. We observed the compliance of 40 patients who all underwent a "ppV" and sulfur hexafluoride-gastamponade (sf6 25%). Patients were randomized preoperatively in a supported group (SG) and a control group (CG). During the observation period the individual behavior and compliance of the patient was recorded by questionnaires. For an additional monitoring we observed the authenticity of the answers by taking sample readings using a temperature-logger.Additionally the contentment of the patient in reference to the available supports and the appearance of complications have been reported.In the postoperative time in hospital the participants of the SG used a simple prone-positioning support. A ergonomic body positioning and a fixed head position was ensured. In the time after hospital at home, the patients were supplied with an inflatable device. All patients were requested to keep their face downwards until the gas bubble was resorbed completely.
In particular the real time of "fdp" in hours per day (24h) varied greatly (SG: 19,5/24; CG: 5,5/24; P<0,0001). Equivalent results were reflected in the contentment in reference to the available supports (SG: 99%; CG: 25%; P<0,0001).Postoperative complications such as moderate or severe back-, neck-or headache only were observed in the CG. Developing a postoperative cataract was observed mainly in the non-supported group. An additional study is in progress.
Placing supports at the disposal of the patients, it is possible to improve significantly thecompliance after surgery. The patients contentment was improved remarkably. The appearance of complications has been reduced by strictly using the supports. To succeed in using the prone position also at home it is necessary to supply the patient with a support which is comfortable, cheap and easy to handle.
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