![]() ![]() For instance, positioning on the temporal side might be optimal for peripheral temporal RD, but a temporal RD that already has progressed close to the fovea might be better positioned supine to support reattachment of the retina closest to the fovea. ![]() This advice does not account for the distance between the fovea and the RD border or the precise location of the closest point on the RD border. Positioning is mostly prescribed in four categories: supine, temporal side, nasal side, and upright. 14 However, the strength of the relationship between compliance to preoperative posturing and RD progression is as yet unknown. Recently, we used optical coherence tomography (OCT) to demonstrate that preoperative posturing reduces the progression of macula-on RD by comparing posturing with interruptions for meals and other short breaks. As both approaches are expensive policies, the understanding of the effectiveness of preoperative posturing warrants further study. An alternative approach is to provide surgery on a 24-hour, 7-days-per-week basis. To improve the compliance with this posturing advice, in some clinics patients are hospitalized during the preoperative period. 6 – 13 Additionally, patients are positioned supine when RD is located in the superior quadrants of the retina and upright for RD in the inferior quadrants to address the effect of gravity. Patients with macula-on RD are prescribed bed rest to reduce head and eye movements and related fluid currents. 3 – 5 To prevent macular involvement, preoperative posturing is prescribed while patients are waiting for surgery. 1, 2 Visual acuity may be severely affected if the RD extends to the macula. Retinal detachment (RD) is a progressive separation of the retina from the underlying retinal pigment epithelium that occurs in 12 to 18 per 100,000 people per year. 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. Preoperative posturing is effective by reducing head movements rather than enforcing head positioning. However, the correlation between RD progression and rotational and linear acceleration was much stronger. ![]() The strength of the correlation between RD progression and compliance was moderate. 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). 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. 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. The head orientation and acceleration were measured with a head-mounted inertial measurement unit (IMU). ![]() Secondary outcome parameters included the average rotational and linear head acceleration. The primary outcome parameter was compliance, which was defined as the average head orientation deviation from advised positioning. Sixteen patients with macula-on RD were enrolled, admitted to the ward, and instructed to posture preoperatively. 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. ![]()
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