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  • Minimizing head movements prior to surgery may be key to slowing RRD progression

    Retina/Vitreous

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    Review of: Preoperative positioning and progression of fovea-on retinal detachments

    Alberti M, Ilsby C, Christensen U, et al. Ophthalmology Retina, in press 2023

    In a small study conducted a few years ago that examined eyes with fovea-on rhegmatogenous retinal detachment (RRD), minimizing head movement between diagnosis and surgery showed significant correlation with slower RRD border progression. With high variability across individuals, however, more studies are needed to fully understand this relationship.

    Study design

    This was a prospective, single-cohort study evaluating the influence of preoperative patient positioning in individuals with fovea-on RRD (distance to the foveal center >750 µm). The study included 50 patients who were diagnosed with fovea-on retinal detachment and subsequently hospitalized for bedrest prior to surgical treatment. All patients wore a head-mounted position sensor beginning just before they underwent a baseline OCT and ending immediately prior to surgery. The primary outcome was shortest distance from the foveal center to RRD border on OCT. Secondary outcomes included measurements of head movement and compliance with positioning.

    Outcomes

    Angular velocity (reflective of the amount of head movement) was the strongest predictor of RRD border movement, with both progression toward and regression from the fovea seen; compliance with recommended protocols showed no significant association with RRD border movement. Increasing head movement correlated with highly variable RRD progression, leading the authors to group RRDs post-hoc into three categories: stable, intermediate, and mobile RRDs.

    Limitations

    The small number of included patients limited the findings of this study. Furthermore, RRD movement groups were defined post-hoc. Better definitions of which RRDs may be mobile vs immobile need to be elucidated to clearly understand the impact of head movement for different patients in order to make appropriate preoperative positioning recommendations.

    Clinical significance

    The relationship between RRD progression and positioning is complex, but this study begins to add evidence that can help develop optimal presurgical positioning or bedrest protocols for patients with fovea-on retinal detachments. I plan to discuss with patients that if they notice a worsening shadow, minimizing head movements may be effective at slowing movement of the RRD.

    Financial Disclosures: Dr. Rebecca Soares discloses no financial relationships.