The Effect of Compliance With Preoperative Posturing Advice and Head Movements on the Progression of Macula-On Retinal Detachment

Abstract

Purpose The aim of this study was to explore the relationship between compliance with preoperative posturing advice and progression of macula-on retinal detachment (RD) and to evaluate whether head positioning or head motility contributes most to RD progression. Methods Sixteen patients with macula-on RD were enrolled, admitted to the ward, and instructed to posture preoperatively. The primary outcome parameter was compliance, which was defined as the average head orientation deviation from advised positioning. Secondary outcome parameters included the average rotational and linear head acceleration. The head orientation and acceleration were measured with a head-mounted inertial measurement unit (IMU). Optical coherence tomography (OCT) imaging was performed at baseline and during natural interruptions of posturing for meals and toilet visits to measure RD progression toward the fovea. Results The Spearman correlation coefficient with RD progression was 0.37 ( P = 0.001, r s 2 = 0.13) for compliance, 0.52 ( P < 0.001, r s 2 = 0.27) for rotational acceleration, and 0.49 ( P < 0.001, r s 2 = 0.24) for linear acceleration. The correlation coefficient between RD progression and rotational acceleration was statistically significantly higher than the correlation coefficient between RD progression and compliance ( P = 0.034). Conclusion The strength of the correlation between RD progression and compliance was moderate. However, the correlation between RD progression and rotational and linear acceleration was much stronger. Preoperative posturing is effective by reducing head movements rather than enforcing head positioning. Translational Relevance Monitoring the efficacy of preoperative posturing in macula-on RD using OCT and IMU measurements shows that a new and combined application of these technologies leads to clinically relevant insights.

Deep learning for detecting retinal detachment and discerning macular status using ultra-widefield fundus images

“…Preoperative posturing on the side where the RD mainly located is an effective strategy to reduce the progression of macula-on RD 28,29 . However, in our view, although macula detachment occurs in partial RD, preoperative posturing is still indispensable as the extent of detachment is positively related to the failure rate of RD repair 30 .…”

Cases of spontaneous reattachment of rhegmatogenous retinal detachment

“…De Jong et al. [ 4 ] concluded that limiting head and eye movements is enough to prevent RRD progression, but it should not be counted as an only contributing factor to SRRRD; the authors supposed that the gravitational force effect on the retina and subretinal fluid is small because of the no density difference between them.…”

Influence of Preoperative Posturing on Subfoveal Fluid Height in Macula-Off Retinal Detachments

“…20 In particular, in patients with loss of central vision within one week, the height of macular elevation seems to be a stronger predictor for visual outcome than duration. 17,19 Preoperative posturing according to the location of the primary retinal break to prevent further accumulation and spreading of subretinal fluid to involve the macula has become an established procedure in patients with macula-on RD, [21][22][23][24] but not in patients in whom the macula is already detached.…”

“…Preoperative posturing according to the location of the primary retinal break to prevent further accumulation and spreading of subretinal fluid to involve the macula has become an established procedure in patients with macula-on RD, 21–24 but not in patients in whom the macula is already detached.…”