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Jan H. de Jong, Tiarah C. Simon, Juan Pedro Vigueras-Guillén, Reinier Timman, Koenraad Arndt Vermeer, Jan C Van Meurs; The influence of interruptions of bed rest with positioning on the progression of macula-on retinal detachment. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1031.
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© ARVO (1962-2015); The Authors (2016-present)
Traditionally, preoperative bed rest and positioning are prescribed to patients with macula-on retinal detachment (RD) to prevent RD progression and detachment of the fovea. Execution of such advice can be cumbersome and expensive. This comparative, non-randomized trial aims to investigate if interruptions of preoperative bed rest and positioning affect the progression of RD.
71 patients with macula-on RD were included. Inclusion criteria were: volume OCT scans can be obtained with sufficient quality; smallest distance from the fovea to the detachment border (SDFD) ≥1.25mm. Patients were admitted to the ward for bed rest in anticipation of their surgery and were positioned on the side where the RD was mainly located. At baseline and before and after each interruption for meals or toilet visits, a 37°x45° OCT volume scan was performed using a wide-angle Spectralis OCT (Heidelberg Engineering, Germany). The SDFD was measured using the built-in measuring tool. The average RD border displacement velocity (BDV) moving towards (negative) or away (positive) from the fovea was calculated for the total duration of bed rest and interruptions per patient. We refer to the quality of adhesion of the attached retina as ‘true adhesion’ in the area between the RD border and fovea at baseline and as ‘pseudo adhesion’ in the area of reattached retina after regression of RD.
The mean SDFD at baseline was 4.9 mm (range: 1.3 – 14.4 mm). The mean time interval during bed rest was 6.8 (95%CI: 5.7 – 8.0) hours and during interruptions 0.38 (CI: 0.37-0.43) hours. The mean BDV was +32 (CI: +5 – +61) µm/hour during bed rest and -322 (CI: -409 – -246) µm/hour during interruptions, which differed statistically significant from each other (p<0.001, see figure). Stratification of the patients based on the primary retinal quadrant of the detachment did not result in statistically significant differences between retinal quadrants. The mean BDV during periods of interruptions starting in true adhesion areas was -177 (CI: -261 – -104) µm/hour and -489 (CI: -608 – -376) µm/hour starting in pseudo adhesion areas, which differed statistically significant (p<0.001, see figure).
RD regresses during bed rest with positioning in patients with macula-on RD and progresses during interruptions. The progression velocity during interruptions is higher if it starts from an area of pseudo adhesion.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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