Clinical characteristics and temporal distribution of face-down posture-related pain after vitrectomy with intraocular tamponade

To investigate the incidence, anatomical distribution, and temporal characteristics of musculoskeletal pain associated with prolonged face-down positioning (FDP) during the first 24 h after pars plana vitrectomy (PPV) with intraocular tamponade, and to evaluate its association with postoperative positional adherence. This prospective observational study enrolled 199 patients who underwent PPV with silicone oil or gas tamponade between September 2025 and January 2026. Pain was assessed every 6 h using the Numeric Rating Scale, and FDP adherence was recorded at 2-hour intervals. Pain incidence, intensity, anatomical distribution, and temporal patterns were analyzed by both chronological time periods (0:00–05:59, 06:00–11:59, 12:00–17:59, 18:00–23:59) and postoperative intervals (0–6 h, 6–12 h, 12–18 h, 18–24 h). Among 199 participants, 124 (62.3%) reported posture-related pain. Muscle soreness was the most common reason for poor adherence (36.2%), followed by prolonged positioning (22.6%) and poor postural adaptation (17.1%). Adherence was lowest during early morning (43.7%) and highest in afternoon/evening, and declined progressively from 68.8% (0–6 h) to 46.4% (18–24 h). Shoulder, neck, and back pain showed relatively stable median scores across all time intervals, whereas arm pain and chest pain showed slightly higher median scores during the 12–18 h postoperative period. Posture-related musculoskeletal pain is highly prevalent during the first 24 h following PPV with intraocular tamponade and represents an important barrier to FDP adherence. The period 12–18 h after surgery showed relatively higher pain scores for chest and upper-limb pain, whereas adherence is poorest during the early morning and after the first 12 postoperative hours. These findings highlight the need for targeted, time-specific nursing strategies, to improve pain management, promote adherence to postoperative positioning, and support postoperative recovery.