Evaluation of prone vs supine positioning in fresh rhegmatogenous retinal detachment treated with pars plana vitrectomy and gas

Abstract

Purpose: To compare Supine versus Prone positioning in fresh rhegmatogenous retinal detachments (RRDs) treated with vitrectomy and gas tamponade. Methods: This was a prospective randomized controlled trial of 72 eyes with fresh RRD who underwent 25-gauge vitrectomy. 37 eyes were allotted supine position and 35 were allotted prone position. Cases were evaluated for single surgery reattachment rates, best corrected visual acuity (BCVA), intraocular pressure (IOP), cataract formation and any complications. The patients were followed up for a period of 3 months. Results: Both groups had similar demographics, and no significant difference was found between the two groups in terms of extent of retinal detachment, position and number of breaks. The anatomical success after single surgery was 97.3% in Supine group and 94.3% in Prone group (p=0.609). The BCVA at the end of 3 months was 0.44 ± 0.27 in Supine group and 0.35 ± 0.27 in Prone group (p=0.119) with a significant increase in BCVA preoperatively from 0.11 ± 0.22 and 0.13 ± 0.22 in Supine and Prone group respectively (p=<0.001). The IOP in the two groups was comparable at each follow up. The rates of cataract formation were also similar in the two groups - 60% and 53.8% in Supine and Prone group respectively(p=1.00). Complications such as spikes in IOP, epiretinal membrane formation, cystoid macular oedema etc were similar in both groups. Conclusion: Rates of retinal reattachment were comparable in both groups, showing that supine position is equally safe and effective for adequate tamponade.