RCH Face Down Postioning Video

Video Transcript

Welcome to Retina Consultants of Houston.

Hello I'm Dr. Richard Fish of Retina Consultants of Houston, today we'll be talking about positioning for patients who have had vitreoretinal surgery. When a patient hears you need a major eye surgery called a vitrectomy and we're putting a gas bubble in your eye requiring you to be face down for a few weeks they are naturally intimidated and scared but let's go through this step by step.

Many retinal conditions are caused by problems of the clear vitreous gel that fills the back of the eye. Retinal tears, detachments, macular holes are some of the conditions that are treated with vitrectomy surgery. At the end of many of our surgeries a gas bubble is injected into the eye, this gas bubble helps the retina to heal similar to the way a splint or a cast helps a broken bone heal.

In order for the bubble to help heal the retina the patient must position themselves post operatively so that the bubble floats to the damaged area of the retina, this requires the patient to be face down or on their side or propped up depending on the condition and the location of the damaged area. Your retinal surgeon will give you specific information about which position he or she wants you to be in and for how long.

Face down positioning is generally best performed using a rented chair or device, several companies offer short term rental of these chairs and devices. Alternatively many patients can comfortably position face down at the kitchen table by using good body mechanics, the key is scooting the chain back, holding the arms on a pillow, and resting the head on the forearms keeping the neck and back straight. The most common mistake that patients make is hunching over bending the back and the neck like a shrimp, this is not really face down positioning and is likely to make the patient uncomfortable and less likely to do the full positioning required.

Gas bubbles are usually either a short acting gas lasting two to three weeks or a long acting gas lasting six to eight weeks. During that time patients can expect that vision will be very poor and limited as gas interferes with the optics of the eye. Eventually the gas bubble is absorbed by the body, becoming smaller and smaller, by then the retina is usually fully healed and vision improves.

Face down positioning is usually full time however patients can get up normally for meals, bathe or shower as normal, go to the bathroom, and to briefly stretch a few times each day. For sleeping special rental devices can be attached to the bed to allow for face down positioning through the night. Some doctors allow their patients to sleep on either side with the head rolled downward but not a true face down position. As much as possible any patient with a gas bubble in the eye should avoid sleeping on the back as this allows the gas bubble to float into a position where it can cause complications.

Other retinal conditions require the patient to be on their left or right side, propped up and angled to one side, or sometimes even straight upright. Be sure to ask your retinal physician which positioning regimen he or she wants you to follow. During post operative positioning activity is usually restricted, eye drops can be given with the patient briefly extending his or her neck to make medication administration easier. No physical activity is allowed and very limited reading as this causes back and forth movement of the operated eye.

Limited work on a laptop is fine as is watching TV through a mirror attached to the special vitrectomy chair. Alternatively catching up on old movies with a laptop, iPad, or other tablet device is a great way to pass the time, on our website I've even listed some of my all time favorite really engaging movies. Most patients who do post operative positioning report that it is more boring than it is uncomfortable.

If you're a patient who has had or is getting ready to have vitreoretinal surgery with a gas bubble you will do fine, particularly if you follow these tips. I hope this video has been helpful, for more information on retinal diseases, surgery, our physicians, and office locations please visit our website www.houstonretina.com. Thank you.