Overview of Head Positioning after retinal procedures.
Why positioning is important after surgery with gas or oil in the eye.
Discussion of different acceptable methods of positioning after surgery.
Discussion of when positioning usually starts and stops after surgery.
Overview of eye anatomy with videos showing the parts of the eye and how the eye works.
Overview of positioning rationale, strategy, and recommendations for patients undergoing macular hole surgery.
Positioning, rationale, and strategy for patients undergoing Pneumatic Retinopexy (office procedure)for Retinal Detachment.
Positioning, rationale, and strategy for patients undergoing Vitrectomy (operating room procedure) for Retinal Detachment.
Positioning, rationale, and recommendations for patients undergoing pneumatic displacement of macular hemorrhage in the office (uncommon procedure).
Overview of different gasses used in the eye reviewing their size and duration of action.
Overview of properties of silicone oil used in the eye.

Head Positioning after Macular Hole Surgery

Eye Labeled

Schematic of Eye Showing Macula on Left

The macula is in the very back of the eye and is the part of the retina responsible for central vision. When you look at a letter on this page or a word, the image of the word is falling on your macula. So when you look up at the sky, your macula is lower than the rest of your eye, when you look down at the floor, your macula is higher than the rest of your eye. Since the gas bubble in your eye will rise, when you are looking at the sky it will float off of your macula, when you are looking toward the floor, it will float onto your macula. So, after macular hole

face down

Eye Looking Down

surgery you need to look toward the floor (really the center of the earth) so the gas bubble in your eye floats onto your macula, usually 90% of the time, usually for a week or two. Remember, it matters where you are looking: you need to be looking toward the center of the earth.

Two Gasses: SF6 and C3F8

There are two different types of gas used commonly for macular hole surgery: sulfur hexafluoride (SF6) and perfluoropropane (C3F8). A bubble of SF6 lasts about 3 weeks in the eye and a bubble of C3F8 lasts about 8 weeks in the eye. The bubbles most easily cover the macular hole when they are big, which is immediately after surgery. So, although it is important to look down after surgery, the positioning becomes most important as the bubble in your eye shrinks. You cannot see well through a gas filled eye. The vision when your eye is filled with gas is like your vision with your eye is open underwater without goggles on: it is blurry and strange. Once the bubble fills less the of the eye, you can see around the edges. Once it fills less than half of the eye, your macula will no longer be covered by the bubble when you are looking straight ahead, and you will be able to see. That is when your doctor can tell if your macular hole has closed. Before that time, without special experimental equipment, your macula cannot be seen clearly enough to determine the status of your macular hole.

C3F8 - Perfluoropropane - Long Acting Gas

For eyes with C3F8, the bubble shrinks to fill about half the eye after a month. The disadvantage of the long acting C3F8 bubble is that patients with C3F8 have poor vision in the operated eye for about a month. The advantage of the long acting C3F8 bubble is that patients with C3F8 can be less strict in positioning. This is because for the critical first few weeks after surgery, which is the first week or two, the C3F8 bubble is big. In some situations, as long as the patient is looking a little down, especially in an eye that has had previous cataract extraction, surgical success rates can be very high with minimal positioning (Reference: 24 hour positioning, Reference: 3 days positioning). So C3F8 can be useful in the eyes of patients who will have difficulty or cannot position post-operatively. It is still important that patients avoid face up positioning, which makes the bubble push against the back of the front of the eye. Also, YOU CANNOT FLY OR GO TO HIGH ALTITUDE with a gas bubble in your eye.

SF6 - Sulfur Hexafluoride - Short Acting Gas

SF6 is the most popular gas for macular hole surgery because it absorbs quickly, usually within 3 weeks. Because the bubble shrinks quickly, patients with SF6 gas bubbles in their eye need to be strict about face down positioning, especially after the first few days, when the bubble gets smaller. When you have a smaller bubble in your eye, you will begin to see around the bubble. Since your eye inverts the image, it will look like you are seeing over the top of the bubble, but you are actually seeing under the bottom of the bubble, since the bubble floats to the highest part of your eye. When your bubble is smaller, and you start to see around the edges, you can tell where the bubble is in your eye. You will notice that, with your head down and your eye looking toward the center of the earth, the bubble will block your central vision. That is the proper position for you to be in--where the bubble blocks your central visison--to help close your macular hole. Sometimes when the bubble is smaller, and you are directly face down, the bubble forms a lens in your eye and you can see things up close, like you would with a magnifying glass. (Reference: 7 day positioning)