Abstract
Purpose :
A randomised controlled trial to evaluate the effect of face-down posturing on retinal displacement and distortion following macula-involving retinal detachment repair.
Methods :
Prospective, single-masked randomised controlled trial across two sites (Moorfields Eye Hospital, London & Tennent Institute of Ophthalmology, Glasgow). 262 patients with macula-involving retinal detachments undergoing repair with vitrectomy and gas tamponade were randomised (1:1) to one of two post-operative posturing regimes: (a) face-down or (b) position to ‘support-the-break’ for a 24-hour period following surgery. Primary outcome was the proportion of patients with retinal displacement detected on fundus autofluorescence imaging in each group at 6 months post-operatively. Secondary outcomes included degree of retinal translocation on FAF imaging, corrected visual acuity, objective distortion score (D chart) and quality of life questionnaire scores 6 months post-operatively.
Results :
262 patients were randomised (241 Moorfields & 21 Tennent Institute), with 41 withdrawals during the study period. At 6 months, retinal displacement was detected in 34% of the face down group vs 47% of the support-the-break group (p=0.2). If ungradable images were excluded, this difference was statistically significant (n=203, p=0.05). At 8 weeks, retinal displacement was detected in 35% of the face down group vs 52% of the support-the-break group (p=0.036). There was no statically significant difference in subjective distortion (59% vs 53%), objective D Chart distortion scores or corrected visual acuity between the two groups at 6 months. Adverse events: retinal re-detachment rate was the same in both groups (12.2%). Retinal folds (outer retina & full thickness retinal folds) were less commonly seen in the face down group (5.3%) vs the support-the-break group (13.5%) (p=0.03).
Conclusions :
Face down posturing reduced the risk of retinal displacement and retinal folds following macula-involving retinal detachment repair, but had no effect of visual acuity, subjective or objective distortion.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.