Analysis Of The Effect Of Preoperative Binocular Patching And Head Positioning On Subretinal Fluid Absorption In Patients With Rhegmatogenous Retinal Detachment

Objective: This study aimed to investigate whether preoperative binocular patching and head position control in patients with rhegmatogenous retinal detachment will reduce the volume of subretinal fluid as well as showing potential influence on operation methods and surgical outcomes or not.To explore the influence factors and the independent influencing factors of the reduction of subretinal fluid.To explore the effect/significance of the reduction of subretinal fluid on scleral buckling and vitrectomy.Methods From April 2017 to December 2017,197 consecutive patients(197 eyes)with rhegmatogenous retinal detachment in Anhui Provincial Hospital affiliated to Anhui Medical University were enrolled in the study.They were randomly divided into 100patients(100eyes)in the experimental group and 97 patients(97eyes)in the control group.Patients in the experimental group were preoperative bilateral patched and heads were positioned in a manner,with the retinal tears at the lowest point of the globe for12-hours(12h)while individuals in the control group left untreated.The age and gender,axial length,preoperative visual acuity,lens state,duration of disease,number and location of the tears/holes,proliferative vitreoretinopathy(PVR)classification were recorded.The height and extent of retinal detachment were observed by direct and indirect binocular ophthalmoscopy and quantitative B-scan ultrasound.Surgical methods were assigned into sclera buckling and vitrectomy based on surgical indications.The surgical method,duration and intraoperative status of each patient were collected,after which their postoperative retinal reattachment and visual acuity recovery were followed up for 3 months.Results Compared with 38 eyes of 100 eyes(38%)in the experimental group,there were only 4 eyes of 97 eyes(4.12%)in the control group with subretinal fluid absorption.There was a significant difference in the reduction of subretinal fluid between two groups(P < 0.05).Individuals,undergoing scleral buckling in the experimental group,were consisted of 27 eyes with subretinal fluid absorption and 31 eyes with no obvious change,and two groups were significantly different in operation time,additional surgical steps,postoperation visual acuity(all P < 0.05).Patients,undergoing vitrectomy in the experimental group,were composed of 11 eyes with subretinal fluid absorption and 31 eyes without resulted alteration,there was no significant difference between the two groups in both operation time and postoperation visual acuity(all P<0.05).However,it appeared to be a significant difference in the experimental group between patients experienced a subretinal fluid resorption and individuals without validated resorption for the PVR grade and the age(both P<0.05).Logistic regression analysis showed that younger age and lighter PVR classification were independent influence factors in promoting subretinal fluid absorption(both P<0.05).Conclusion Preoperative binocular patching and specific head positioning can markedly decrease the subretinal fluid especially for young patients with mild PVR grade.For patients who underwent scleral buckling,it did not only shorten the operation time but also reduce the operation chance of subretinal fluid discharge.Apart from that,it can improve the postoperative visual acuity.It could reduce the scleral buckling surgery time and improve postoperative visual acuity.However,for patients who performed vitrectomy,there was no such significance on that.