for instance , in the past , most cataract operations required a hospitalization period , but 1-day surgery is common these days . these changes were made not only by the development of medical technologies that allowed less invasive procedures , but also by reevaluating medical considerations about excessive treatments or admissions that might have been customary but unsubstantiated . retinal detachment is separation of the sensory retina layer from the retinal pigment epithelium layer ; rhegmatogenous retinal detachment ( rrd ) is the most frequent form . buckling or pars plana vitrectomy are common procedures for treatment of rrd , with anatomical success rates of 79%93%.36 formerly , patients were generally hospitalized for postoperative positional stabilization and recovery from general anesthesia in the buckling procedure ; however , there is not enough evidence to support positional stabilization , and the development of other procedures and anesthetic agents has made general anesthesia unnecessary . therefore , we evaluated the clinical outcomes of ambulatory buckling surgery , comparing outpatient- with inpatient - based surgery . from january 2009 to december 2011 , 80 consecutive patients who were diagnosed with rrd and able to be followed up for more than 6 months after scleral buckling in keimyung university , dongsan medical center were included in this study . fifty hospitalized patients were defined as group 1 , and 30 patients who underwent 1-day surgery without admission were defined as group 2 . all buckling surgeries were performed on the day when the rrd was diagnosed . in principle , patients were hospitalized for surgery ; outpatient - based surgeries were performed only when a bed was not available . patients who had other retina lesions , such as retinal vascular disease or macular degeneration , grade c proliferative vitreoretinopathy , or a history of treatment for retinal detachment or breaks , as well as those with planned elective buckling surgeries , were excluded . after localization of retinal break with indirect ophthalmoscopy , a silicone sponge was placed using a 5 - 0 dacron ( alcon surgical inc . , fort worth , tx , usa ) or ethibond excel polyester suture ( ethicon inc . , somerville , nj , usa ) . external drainage of subretinal fluid was followed . when buckle height was insufficient , sulfur hexafluoride ( sf6 ) gas was injected into the vitreous cavity at the end of the operation and the patients were positioned postoperatively so that the bubble was in contact with the retinal break , and the retinal break was flattened against the sclera buckle.7 the next day , demarcation photocoagulation laser was applied , instead of intraoperative cryotherapy . after surgery , inpatients had bed rest , except for toileting and meals , and they were discharged 2 days after surgery . outpatients went home after surgery , rested , and visited the hospital the next day . best - corrected visual acuity ( bcva ) , slit - lamp biomicroscopy , intraocular pressure , and funduscopy were evaluated preoperatively and postoperatively at 1 day , 1 week , and 1 , 3 , and 6 months . anatomical success was defined as macular attachment and no aggravation of retinal detachment on optical coherence tomography and fundus examination . the criteria of functional success were that the bcva was over 20/40 or improved by more than two lines in the snellen chart ; if the preoperative bcva was less than 20/200 , functional success was defined as improvement of more than one step : for example , when visual acuity was improved from light perception to hand movement , hand movement to finger count , or finger count to above 0.1 . when additional surgery was required for the treatment of rrd , it was considered a fail anatomically and functionally . statistical analysis was calculated using spss software ( version 17.0 ; ibm corporation , armonk , ny , usa ) . the independent t - test and pearson s chi - square test were used for comparison of two groups . null hypotheses of no difference were rejected if p - values were less than 0.05 . the mean age of group 1 ( 50 cases ) was 49.7 years and that of group 2 ( 30 cases ) was 47.5 years . there were no statistically significant differences between the two groups in preoperative logmar visual acuity each of 0.41 ( group 1 ) , 0.40 ( group 2 ) , lens condition , or peripheral retinal lattice degeneration ( table 1 ) . there were also no statistically significant differences in retinal break type or aspect of retinal detachment between group 1 and group 2 ( table 2 ) . during the surgical procedure , there were no statistically significant differences in size of the silicone sponge or intravitreous sf6 gas injection during scleral buckling ( table 3 ) . the changes between bcva preoperatively and at 6 months postoperatively were 0.26 ( group 1 ) and 0.31 ( group 2 ) , respectively ; and not significantly different , although group 2 had a higher score . six months after the surgery , the functional success rates were 90% ( group 1 ) and 93% ( group 2 ) , and the anatomical success rates were 94% ( group 1 ) and 96% ( group 2 ) . there was no significant difference in functional success rate and anatomical success rate between the two groups ( table 4 ) . there were no statistically significant differences in anatomical and functional success rates or in visual prognosis between inpatient and outpatient buckling surgery . as medical technologies develop , not only final outcome but also convenience and expedience of the treatment are considered important , and unnecessary or excessive bed rest , postures , and hospital stay are regarded as overtreatment.1 medical recommendations about posture , rest , and hospitalization are being researched , with some being described as excessive and exaggerated.2 for example , absolute bed rest and bilateral patching with head elevation were the standard care of traumatic hyphema in the past . one study has suggested that bilateral patching and bed rest might decrease rebleeding in patients with traumatic hyphema;8 on the other hand , no benefit to the prevention of rebleeding has been proved by hospitalization or enforced bed rest.912 in macular hole treatment , there is controversy about postoperative face - down posture and its duration.13 retinal detachment has a position - dependent pathophysiology , which means that the severity and the progression of the disease are dependent on the location of the retinal tear.14,15 therefore , attempts to estimate the location of a retinal tear from the shape of retinal detachment , or the severity or progression of the disease from the position prior to the surgery , have been made.15,16 barr reported that the patients who had bed rest and a binocular patch prior to a surgical intervention showed a better surgical outcome among patients with retinal detachment of similar severity.17 nevertheless , previous studies dealt mostly with pretreatments of a surgical intervention,17 and there is a lack of evidence supporting any therapeutic positions or periods of bed rest following a surgical intervention . in general , ambulation to the bathroom and normal diet are allowed on the following day of scleral buckling , but bed rest for the first 23 days is recommended in practice . patients are usually hospitalized for 45 days after surgery , with 24 weeks of recuperation recommended after discharge . some insist that a position that faces the tear upwards is the best , because subretinal fluid should be further away from the tear , while some say that a position leading to the tear facing downwards is the best , in order to minimize the effect from the gravity ; still others maintain that resting in supine position is sufficient.18,19 it remains unclear whether there is an optimal position or if an optimal position is truly necessary . considering the pathogenesis of retinal detachment , minimal mobilization minimizes the instability of the damaged retina and prevents further progression of the disease;2,20,21 however , it is unreasonable to think that the level of ambulation will affect the surgical outcome after the retinal tear is already repaired . this study evaluated the need for hospitalization and bed rest immediately after scleral buckling in patients with retinal detachment . the patients were categorized into two groups : the patients who had bed rest in the hospital ( group 1 ) and the patients who recuperated at home ( group 2 ) . there were no statistically significant differences in the characteristics of the patients in each group prior to the surgery , such as age , sex , and visual acuity , or in the severity of retinal detachment or the size or number of tears . moreover , there were no statistically significant differences in the changes between bcva preoperatively and at 6 months postoperatively or in functional and anatomical success rates between the groups . in fact , it was group 2 that showed more improved eyesight and better anatomical and functional success rates , with slight but insignificant differences . relatively mild retinal detachment is treated in the outpatient department in some hospitals , but patients undergoing surgery due to retinal detachment in keimyung university , dongsan medical center were considered inpatients and were admitted to the hospital , rather than hospitalization being decided depending on the severity of retinal detachment or convenience . outpatient - based surgeries were only performed if there were unavoidable logistical problems in the hospital . the working hypothesis was that there is no difference , while , logically , what an author must do is disprove the hypothesis that there is a difference . unfortunately , lack of a difference can occur for many reasons , including a simple lack of statistical power . in addition , this study did not have enough patients for a noninferiority study , even with a 10% significance level . group 2 , however , was not inferior to group 1 at a 15% statistical significance level . the research power of the study is not strong due to its retrospective nature and small sample size . further prospective , noninferior , randomized clinical trials should be conducted to increase the research power and confirm whether hospitalization is necessary for buckling surgery or not . hospitalization after scleral buckling for retinal detachment does not have a significant effect on visual acuity after the surgery or on the surgical success rate .
purposeto evaluate the clinical outcomes of ambulatory buckling surgery , comparing outpatient- with inpatient - based surgery.methodsthe authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from january 2009 to december 2011 treated by scleral buckling surgery . 
 two groups of patients were defined according to inpatient ( group 1 ) or outpatient ( group 2 ) surgery , and a comparison of several parameters between these two groups was performed.resultsof the 80 subjects in this study , the average age of group 1 ( 50 patients ) was 49.7 years , and that of group 2 ( 30 patients ) was 47.5 years . there were no statistically significant differences in the average logarithm of the minimum angle of resolution - visual acuity , the condition of the lens , or the presence of retinal lattice degeneration prior to the surgery between the groups . 
 there were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups . comparing the best - corrected visual acuity after 6 months with that prior to the surgery , 
 the changes in group 1 and group 2 were 0.26 and 0.31 , respectively . 
 the functional success rates of group 1 and group 2 after 6 months were 90% and 93% , respectively , and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96% , respectively , but these were also statistically insignificant.conclusionhospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery .