The Influence of Prolongation of Interruptions of Preoperative Posturing and Other Clinical Factors on the Progress of Macula-On Retinal Detachment

Abstract

To evaluate whether prolongation of interruptions of preoperative posturing by sitting upright influences retinal detachment (RD) progression. The secondary objective was to find clinical factors to identify patients with a high risk for RD progression. Prospective cohort study. One hundred ninety-eight patients divided among 3 cohorts of patients with macula-on RD were included. Inclusion criteria were volume OCT scans of sufficient quality and smallest distance from the fovea to the detachment border of at least 1.25 mm. In the second and third cohort, 50 patients with only superior temporal RD were included. Patients were admitted to the ward in anticipation of surgery. Preoperative bed rest and positioning were prescribed. The position of the RD border was determined based on OCT imaging performed at baseline, before and after the usual interruptions for meals or toilet visits. The duration of interruptions was prolonged with sitting upright for 20 minutes in cohort 2 and for 40 minutes in cohort 3. Various secondary outcome measures were defined, such as the baseline area of subretinal fluid (SRF) as measured on ultrasound images in the third cohort. The RD border displacement was determined. The worst RD progression from baseline was given by the shortest distance to the fovea in any of the OCT scans during follow-up. The worst relative RD progression from baseline was defined as the worst RD progression from baseline as a percentage of the baseline distance between RD border and fovea. The median duration of interruptions was 22, 41, and 58 minutes in cohorts 1, 2, and 3, respectively. The median RD border displacement during interruptions in patients with superior temporal RD was not significantly different among the cohorts (P= 0.28). The correlation coefficient between the SRF area at baseline and worst relative RD progression from baseline was 0.37 (95% confidence interval, 0.04-0.66; P= 0.009). We did not find a significant increase in RD progression after prolongation of interruptions by sitting upright. Patients with a larger area of SRF on ultrasound showed more RD progression from baseline.