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Old 02-07-2013, 10:51 PM   #1
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Why face-up sleeping position is not allowed after vitrectomy+air bubble?

I had vitrectomies done on both my eyes recently for retinal detachments (RD) and an air bubble was used in both surgeries, and I have been wondering why 'face down' position is to be strictly followed, and 'face-up' is not allowed at all. The face down condition is a pain, if for many days, and the neck hurts and my chest gets too much pressure and breathing becomes difficult. The number of days to be in face-down differed in both cases: for the peripheral RD on one eye it was fewer hours than the macular RD on the other eye, although I had cataract surgeries and IOL in both eyes several years before the vitrectomy surgeries.

The most common reason, I have read, is that that when in face-down position the air bubble presses on the central macular portion and flattens it, but if there is some fluid/saline solution in the eye-ball after the vitrectomy then with a face-up position even that fluid and the air on top of it will have similar pressure on the macula and should press the macula down too. There must be other reasons for not keeping the face-up position when sleeping - the face-up position actually would make life a little bit more comfortable when the air bubble is present. [I was allowed sleeping on the right side later, and I have seen sleeping equipment to ease the pain but don't want to use it.] I am trying to find out all the reasons you know or your doctor may have told you for not using the face-up position. Does it have anything to do with accelerated formation of cataract or glaucoma, higher ocular pressure, fluid going under the retinal tear, etc.? Thanks.

Last edited by vitcat2; 02-08-2013 at 10:09 AM. Reason: rephrasing the last sentence

 
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Old 02-08-2013, 11:04 AM   #2
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Re: Why face-up sleeping position is not allowed after vitrectomy+air bubble?

Quote:
Originally Posted by vitcat2 View Post
I had vitrectomies done on both my eyes recently for retinal detachments (RD) and an air bubble was used in both surgeries, and I have been wondering why 'face down' position is to be strictly followed, and 'face-up' is not allowed at all. The face down condition is a pain, if for many days, and the neck hurts and my chest gets too much pressure and breathing becomes difficult. The number of days to be in face-down differed in both cases: for the peripheral RD on one eye it was fewer hours than the macular RD on the other eye, although I had cataract surgeries and IOL in both eyes several years before the vitrectomy surgeries.

The most common reason, I have read, is that that when in face-down position the air bubble presses on the central macular portion and flattens it, but if there is some fluid/saline solution in the eye-ball after the vitrectomy then with a face-up position even that fluid and the air on top of it will have similar pressure on the macula and should press the macula down too. There must be other reasons for not keeping the face-up position when sleeping - the face-up position actually would make life a little bit more comfortable when the air bubble is present. [I was allowed sleeping on the right side later, and I have seen sleeping equipment to ease the pain but don't want to use it.] I am trying to find out all the reasons you know or your doctor may have told you for not using the face-up position. Does it have anything to do with accelerated formation of cataract or glaucoma, higher ocular pressure, fluid going under the retinal tear, etc.? Thanks.
Hi,
I had a vitrectomy due to vitreous gel attaching to my retina. I had to keep the head down position also, and my understanding was that it would help the bubble stay in place and make the retina more secure.
I know it'a a pain, and my neck was sore for a long time even when i could look up again.
I did have a cataract start forming in about 5 months after the vitrectomy, but the dr. had told me I would get one withing a year to 5 years, so I don't think the head-down position had anything to do with it.
I would follow the dr. instructions.
good luck

 
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Old 02-14-2013, 08:44 AM   #3
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Re: Why face-up sleeping position is not allowed after vitrectomy+air bubble?

I found a couple of "root-causes" from seemingly authentic web-sites: With face-up position the air-bubble floats on the top and touches the lens side, of course, and not the macula on the backside of the retina. When that happens,
1. The air touches the posterior (backside) capsular bag that holds the natural lens; this can somehow lead to accelerated formation of cataracts/clouding in that lens; with face-down position, on the other hand, the air bubble is away from the capsular bag, and whatever liquid is there in the eye ball will be on the lens side, and alleviates this from happening. So, then my question is : when the face is positioned to the right or left, while sleeping, as is often recommended after a few days of vit. sx, if there is still some air bubble volume and not fully filled with saline solution, it may still touch the lens. So, still must be worrisome...May be, somebody has the answer for it.
2. Secondly, (and I am not too sure about this mechanism), it seems there is some opening port and canal in the eye which balances the occular pressure by controlling the fluid leakage in/out, and which happens to be on the anterior or front side. With air near that port, and not liquid, this may not function properly, and can increase the occular pressure and accelerate the formation of glaucoma. With face down, there is some liquid there.
Of course, whether we know the actual reasons or not, as 'eyemar' says, we need to simply follow "strictly" what the dr says in each case for fastest macular RD recovery.

 
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Old 02-14-2013, 12:00 PM   #4
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Re: Why face-up sleeping position is not allowed after vitrectomy+air bubble?

Quote:
Originally Posted by vitcat2 View Post
I found a couple of "root-causes" from seemingly authentic web-sites: With face-up position the air-bubble floats on the top and touches the lens side, of course, and not the macula on the backside of the retina. When that happens,
1. The air touches the posterior (backside) capsular bag that holds the natural lens; this can somehow lead to accelerated formation of cataracts/clouding in that lens; with face-down position, on the other hand, the air bubble is away from the capsular bag, and whatever liquid is there in the eye ball will be on the lens side, and alleviates this from happening. So, then my question is : when the face is positioned to the right or left, while sleeping, as is often recommended after a few days of vit. sx, if there is still some air bubble volume and not fully filled with saline solution, it may still touch the lens. So, still must be worrisome...May be, somebody has the answer for it.
2. Secondly, (and I am not too sure about this mechanism), it seems there is some opening port and canal in the eye which balances the occular pressure by controlling the fluid leakage in/out, and which happens to be on the anterior or front side. With air near that port, and not liquid, this may not function properly, and can increase the occular pressure and accelerate the formation of glaucoma. With face down, there is some liquid there.
Of course, whether we know the actual reasons or not, as 'eyemar' says, we need to simply follow "strictly" what the dr says in each case for fastest macular RD recovery.
Hi Vitcat,
Thanks for that reply. I wondering if after I have my cataract surgery, since I am post vitrectomy, if I will have to have that YAG surgery also.
Do you have any thoughts/ideas about that?
hope you hear from you,
eyemar

 
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Old 02-14-2013, 06:00 PM   #5
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Re: Why face-up sleeping position is not allowed after vitrectomy+air bubble?

If you are going to have a cat sx after your vit. sx has already been done, then still the possibility of a "secondary cataract" may still exist in that eye, I think, as a risk factor after any cat. sx. Remember, this is a possibility, not a certainty. In my case, my right eye had a secondary cataract, but the left eye did not, although both had a cat. sx one month apart, some 11 years ago. In any case, secondary cat. is not usually a big thing, even if it happens - the dr uses an Nd:Yag laser treatment on an out-patient basis (for a few minutes) to remove the secondary cataract which can form on the posterior (or, backside) capsular bag which holds the IOL (artificial lens). Your vision immediately becomes clear again, and you can see and drive the next day. Normally, it doesn't re-appear. I had my YAG laser 2 or 2.5 years after the cat. sx when I again started seeing the usual signs of cat. in that eye.

From the web, I gather that the sec. cat. can happen due to residual natural lens cells that may remain in the capsular bag from the original cat. sx. even after ultrsonic emulsification and suction that they use to remove the original lens. It is our eye's natural response to actually build another lens from those residual cells, but it is a halfway attempt, and simply accumulates on the capsular bag as a cloud of cells. Some lens cells may remain at the edge of the posterior and anterior capsular bag (on their rim), if the original lens cells are not completely sucked during the cat. sx., and then they can proliferate on the posterior capsular bag to create the sec. cat. The Yag laser cuts a small circle in the posterior calpsular bag and that disc-material goes into the vitreous behind and is absorbed naturally. There are some other mechasims also.

However, the good news is - sec. cat., or its sx, is not a big deal, and you shouldn't worry about it much, at this stage any way.

 
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Old 02-15-2013, 05:12 AM   #6
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Re: Why face-up sleeping position is not allowed after vitrectomy+air bubble?

Quote:
Originally Posted by vitcat2 View Post
If you are going to have a cat sx after your vit. sx has already been done, then still the possibility of a "secondary cataract" may still exist in that eye, I think, as a risk factor after any cat. sx. Remember, this is a possibility, not a certainty. In my case, my right eye had a secondary cataract, but the left eye did not, although both had a cat. sx one month apart, some 11 years ago. In any case, secondary cat. is not usually a big thing, even if it happens - the dr uses an Nd:Yag laser treatment on an out-patient basis (for a few minutes) to remove the secondary cataract which can form on the posterior (or, backside) capsular bag which holds the IOL (artificial lens). Your vision immediately becomes clear again, and you can see and drive the next day. Normally, it doesn't re-appear. I had my YAG laser 2 or 2.5 years after the cat. sx when I again started seeing the usual signs of cat. in that eye.

From the web, I gather that the sec. cat. can happen due to residual natural lens cells that may remain in the capsular bag from the original cat. sx. even after ultrsonic emulsification and suction that they use to remove the original lens. It is our eye's natural response to actually build another lens from those residual cells, but it is a halfway attempt, and simply accumulates on the capsular bag as a cloud of cells. Some lens cells may remain at the edge of the posterior and anterior capsular bag (on their rim), if the original lens cells are not completely sucked during the cat. sx., and then they can proliferate on the posterior capsular bag to create the sec. cat. The Yag laser cuts a small circle in the posterior calpsular bag and that disc-material goes into the vitreous behind and is absorbed naturally. There are some other mechasims also.

However, the good news is - sec. cat., or its sx, is not a big deal, and you shouldn't worry about it much, at this stage any way.
Hi Vitcat,
Thanks so much for your reply. I'm trying not to worry about the cataract surgery, and any post stuff that happens, just want to be informed about possibilities. I'll be so glad when it's over.
Thanks again for your reply,
eyemar

 
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retinal detachment, vitrectomy, vitrectomy induced cataract



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