[Significant improvement in compliance with the face-down position after vitrectomy and gas tamponade]

The positioning of a patient in a "prone position" ("face down position", fdp) after pars plana vitrectomy with gas tamponade has been discussed controversially since the beginning of macular surgery. The "prone positioning" is almost standard although the duration varies. In most of the study designs for macular surgery "face-down positioning" is advised. However it is not clearly described how the "prone position" was achieved. In most of the studies it is not shown if the patients had suitable aids and how long and how efficiently they used them. Experience while practising this shows that the patient's compliance is a great challenge. Patients are mostly unable to comply, which could result in refusal.

In our prospective, controlled and randomised pilot study we observed postoperatively 40 patients who all underwent a pars-plana vitrectomy and sulfur hexafluoride-gastamponade (SF6 25%). All patients of the supported group (SG) and the control group (CG) were requested to keep their face downwards until the gas bubble was resorbed completely. In the postoperative time in hospital the participants of the SG used a simple prone-positioning support. In the time at home after hospital, the patients were supplied with an inflatable device. In this trial we wanted to show whether or not it is possible to improve the patient's compliance by using a prone-positioning support, designed to be particularly comfortable, so that real time in "face-down position" in hours per day could be increased significantly. Additionally, the contentment of the patient in reference to the available supports and the appearance of complications has been reported.

In particular the real time of "fdp" in hours per day (24 h) 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. Development of a postoperative cataract was observed mainly in the non-supported group.

By placing supports at the disposal of the patients, it is possible to improve significantly the compliance after surgery. 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.