Impact of postoperative positioning on surgical and visual outcomes after pars plana vitrectomy for rhegmatogenous retinal detachment: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: INTRODUCTION: Rhegmatogenous retinal detachment (RRD) is a serious ophthalmic pathology managed with pars plana vitrectomy (PPV) with gas tamponade. Even though prone position after surgery is widely used, it has been questioned because of high patient discomfort and contradictory evidence concerning its effects on functional outcomes. OBJECTIVE: To assess the effect of various positioning options post-surgery on the rate of retinal reattachment and visual outcome after PPV for RRD. METHODS: A systematic review and meta-analysis were carried out in accordance with the PRISMA statement. Searches for related papers in PubMed, Scopus, and Web of Science databases were made up to April 2026. Articles describing postoperative positioning after PPV for RRD were considered for inclusion. Primary outcomes were retinal reattachment rate and changes in best corrected visual acuity (BCVA). RESULTS: Ten studies with 1262 eyes were included. Pooled analysis showed no statistically significant difference in retinal reattachment rate between prone/face-down positioning and support-the-break/adjustable positioning (RR = 0.96, 95% CI 0.84 to 1.11, p = 0.231), with moderate heterogeneity. The evidence for reattachment rate outcome was of low certainty. Two studies with 90 eyes showed a very small borderline difference in logMAR BCVA change in favour of prone positioning versus supine positioning (MD = -0.07, 95% CI -0.14 to 0.00, p = 0.049). However, the certainty of evidence for this comparison was very low. The clinical relevance of this small difference is uncertain. Descriptive single-arm analyses demonstrated postoperative improvement in BCVA for both the prone and supine positioning arms, nonetheless, there was significant heterogeneity in these analyses. CONCLUSION: In the pooled analysis, there was no statistically significant difference in the rate of retinal reattachment between prone positioning and support-the-break positioning after PPV for RRD, and the certainty of evidence for this outcome was low. For BCVA, the pooled analysis showed a small borderline difference in logMAR BCVA in favour of prone positioning versus supine positioning. However, the certainty of evidence for this comparison was very low and the clinical importance of this finding is unclear. Thus, the current evidence does not allow a strong conclusion of clinically meaningful functional superiority of prone positioning. Postoperative positioning should be determined by the location of the retinal break, the tamponade agent, surgical factors, patient tolerance, and the judgment of the clinician. CLINICAL TRIAL NUMBER: Not applicable.
Language: English
Topic: Retinal and Macular Surgery
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,890
OpenAlex ID: W7165872327