Preoperative posturing limits RD progression

Investigators examined the effect of preoperative posturing on preventing progression of retinal detachments (RD).

Study design

This prospective study included 98 patients with macula-on RDs. Preoperative posturing consisted of bed rest and positioning patients on the side where the RD was mainly located.

OCT scans were obtained at baseline and before and after each interruption in positioning for meals or bathroom visits. Using these images, the authors measured the distance of RD border displacement and the displacement velocity moving toward (negative) or away (positive) from the fovea.

Outcomes

The authors found significant evidence that RD stabilizes during posturing and progresses during interruptions.

The median RD border displacement was 2 microns during posturing, and −61 microns during interruptions (P<0.001). The median RD border displacement velocity was +1 microns/hour during posturing, and −149 microns/hour during interruptions (P<0.001).

Limitations

Translating these findings into a clinical setting will require physician judgement, as each RD case is unique.

Clinical significance

The findings clearly show that preoperative positioning of patients with macula-on RDs can decrease progression of the detachment. Thus, positioning is highly beneficial in cases where surgery must be delayed.

The authors suggest that future studies should monitor posturing compliance using positioning sensors, which would give insight into whether restricting head movements or gravity is related to RD progression.