Problems with body position after vitrectomy surgery

After vitrectomy surgery, some patients need to receive intraocular filling with long-lasting gas or silicone oil to help reset the retina and to maintain a special position after surgery. I often hear my fellow ophthalmologists and patients talk about how well they “crawl”. In fact, the postoperative position, called “crawl” position, is not correct and comprehensive. The golden position is to maintain the vertical axis position when the operated eye is facing downward, that is, the patient’s face is parallel to the ground. One is to make full use of the surface tension, buoyancy and refill force of the refill to press on the retina and help the retina to reset; the other is to avoid the pressure of the refill on the lens and atrial angle in the front of the eye to prevent cataract due to the increase of intraocular pressure and lens damage. Therefore, the vertical axial position of the eye facing upward is to be absolutely avoided. In our unit and during outpatient visits, we often see a scene where the patient’s jaws are placed on a pillow to maintain a “crawl” position. The patient told that the doctor explained that “it is good to crawl back to the post-operative room”. Indeed, it is not uncommon to hear young doctors tell their patients to “crawl” when they return to their wards at the end of surgery. This is a customary phrase and is often said by fellow ophthalmologists. In fact, this position, when the eye axis is in the horizontal axis position, is not optimal for patients with macular surgery, it should be the forehead on the pillow, crawl position, or sitting position, commonly known as face down. For patients with retinal fissures above, it is possible to maintain a proper sitting position or alternating side lying, and the patient will indeed suffer a lot less, but it must be done under the guidance of the doctor to prevent and control IOP elevation, crystal damage or silicone oil entering the anterior chamber. Therefore, it is important to remind our doctors that they should be as complete as possible when explaining the postoperative position of the patient, and the phrase “crawl well when you return to the ward” is not complete enough.