Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair: The PostRD Randomized Clinical Trial | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Mitry  D, Williams  L, Charteris  DG, Fleck  BW, Wright  AF, Campbell  H.  Population-based estimate of the sibling recurrence risk ratio for rhegmatogenous retinal detachment.   Invest Ophthalmol Vis Sci. 2011;52(5):2551-2555. doi:10.1167/iovs.10-6375 PubMedGoogle ScholarCrossref
Jackson  TL, Donachie  PHJ, Sallam  A, Sparrow  JM, Johnston  RL.  United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 3, retinal detachment.   Ophthalmology. 2014;121(3):643-648. doi:10.1016/j.ophtha.2013.07.015 PubMedGoogle ScholarCrossref
Dell’Omo  R, Mura  M, Lesnik Oberstein  SY, Bijl  H, Tan  HS.  Early simultaneous fundus autofluorescence and optical coherence tomography features after pars plana vitrectomy for primary rhegmatogenous retinal detachment.   Retina. 2012;32(4):719-728. doi:10.1097/IAE.0b013e31822c293e PubMedGoogle ScholarCrossref
Okamoto  F, Sugiura  Y, Okamoto  Y, Hiraoka  T, Oshika  T.  Metamorphopsia and optical coherence tomography findings after rhegmatogenous retinal detachment surgery.   Am J Ophthalmol. 2014;157(1):214-220.e1. doi:10.1016/j.ajo.2013.08.007 PubMedGoogle ScholarCrossref
van de Put  MAJ, Vehof  J, Hooymans  JMM, Los  LI.  Postoperative metamorphopsia in macula-off rhegmatogenous retinal detachment: associations with visual function, vision related quality of life, and optical coherence tomography findings.   PLoS One. 2015;10(4):e0120543. doi:10.1371/journal.pone.0120543 PubMedGoogle Scholar
Lina  G, Xuemin  Q, Qinmei  W, Lijun  S.  Vision-related quality of life, metamorphopsia, and stereopsis after successful surgery for rhegmatogenous retinal detachment.   Eye (Lond). 2016;30(1):40-45. doi:10.1038/eye.2015.171 PubMedGoogle ScholarCrossref
Shiragami  C, Shiraga  F, Yamaji  H,  et al.  Unintentional displacement of the retina after standard vitrectomy for rhegmatogenous retinal detachment.   Ophthalmology. 2010;117(1):86-92.e1. doi:10.1016/j.ophtha.2009.06.025 PubMedGoogle ScholarCrossref
Dell’omo  R, Cifariello  F, Dell’omo  E,  et al.  Influence of retinal vessel printings on metamorphopsia and retinal architectural abnormalities in eyes with idiopathic macular epiretinal membrane.   Invest Ophthalmol Vis Sci. 2013;54(12):7803-7811. doi:10.1167/iovs.13-12817 PubMedGoogle ScholarCrossref
Lee  E, Williamson  TH, Hysi  P,  et al.  Macular displacement following rhegmatogenous retinal detachment repair.   Br J Ophthalmol. 2013;97(10):1297-1302. doi:10.1136/bjophthalmol-2013-303637 PubMedGoogle ScholarCrossref
Martínez-Castillo  VJ, García-Arumí  J, Boixadera  A.  Pars plana vitrectomy alone for the management of pseudophakic rhegmatogenous retinal detachment with only inferior breaks.   Ophthalmology. 2016;123(7):1563-1569. doi:10.1016/j.ophtha.2016.03.032 PubMedGoogle ScholarCrossref
Chen  X, Yan  Y, Hong  L, Zhu  L.  A comparison of strict face-down positioning with adjustable positioning after pars plana vitrectomy and gas tamponade for rhegmatogenous retinal detachment.   Retina. 2015;35(5):892-898. doi:10.1097/IAE.0000000000000413 PubMedGoogle ScholarCrossref
Dell’Omo  R, Semeraro  F, Guerra  G,  et al.  Short-time prone posturing is well-tolerated and reduces the rate of unintentional retinal displacement in elderly patients operated on for retinal detachment.   BMC Surg. 2013;13(suppl 2):S55. doi:10.1186/1471-2482-13-S2-S55 PubMedGoogle ScholarCrossref
Shiragami  C, Fukuda  K, Yamaji  H, Morita  M, Shiraga  F.  A method to decrease the frequency of unintentional slippage after vitrectomy for rhegmatogenous retinal detachment.   Retina. 2015;35(4):758-763. doi:10.1097/IAE.0000000000000383 PubMedGoogle ScholarCrossref
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053PubMedGoogle ScholarCrossref
McGowan  G, Yorston  D, Strang  NC, Manahilov  V.  D-CHART: a novel method of measuring metamorphopsia in epiretinal membrane and macular hole.   Retina. 2016;36(4):703-708. doi:10.1097/IAE.0000000000000778 PubMedGoogle ScholarCrossref
Wickham  L, Bunce  C, Wong  D, McGurn  D, Charteris  DG.  Randomized controlled trial of combined 5-Fluorouracil and low-molecular-weight heparin in the management of unselected rhegmatogenous retinal detachments undergoing primary vitrectomy.   Ophthalmology. 2007;114(4):698-704. doi:10.1016/j.ophtha.2006.08.042 PubMedGoogle ScholarCrossref
Heimann  H, Bartz-Schmidt  KU, Bornfeld  N, Weiss  C, Hilgers  RD, Foerster  MH; Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group.  Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study.   Ophthalmology. 2007;114(12):2142-2154. doi:10.1016/j.ophtha.2007.09.013 PubMedGoogle ScholarCrossref
Martínez-Castillo  V, Boixadera  A, Verdugo  A, García-Arumí  J.  Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position.   Ophthalmology. 2005;112(7):1222-1226. doi:10.1016/j.ophtha.2004.12.046 PubMedGoogle ScholarCrossref
Peiretti  E, Nasini  F, Buschini  E,  et al.  Optical coherence tomography evaluation of patients with macula-off retinal detachment after different postoperative posturing: a randomized pilot study.   Acta Ophthalmol. 2017;95(5):e379-e384. doi:10.1111/aos.13397 PubMedGoogle ScholarCrossref
McBain  HB, Au  CK, Hancox  J,  et al.  The impact of strabismus on quality of life in adults with and without diplopia: a systematic review.   Surv Ophthalmol. 2014;59(2):185-191. doi:10.1016/j.survophthal.2013.04.001 PubMedGoogle ScholarCrossref
Ugarte  M, Williamson  TH.  Horizontal and vertical micropsia following macula-off rhegmatogenous retinal-detachment surgical repair.   Graefes Arch Clin Exp Ophthalmol. 2006;244(11):1545-1548. doi:10.1007/s00417-006-0290-x PubMedGoogle ScholarCrossref
Dell’Omo  R, Scupola  A, Viggiano  D,  et al.  Incidence and factors influencing retinal displacement in eyes treated for rhegmatogenous retinal detachment with vitrectomy and gas or silicone oil.   Invest Ophthalmol Vis Sci. 2017;58(6):BIO191-BIO199. doi:10.1167/iovs.17-21466 PubMedGoogle ScholarCrossref
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    Original Investigation
    April 16, 2020

    Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair: The PostRD Randomized Clinical Trial

    Author Affiliations
    • 1Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
    • 2Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, United Kingdom
    • 3Unit of Medical Statistics, Faculty of Life Sciences, King’s College London School of Population Health & Environmental Sciences, London, United Kingdom
    JAMA Ophthalmol. 2020;138(6):634-642. doi:10.1001/jamaophthalmol.2020.0997
    Key Points

    Question  Does face-down positioning after macula-involving retinal detachment repair reduce retinal displacement or distortion postoperatively?

    Findings  In this randomized clinical trial of 262 patients with macula-involving retinal detachment, face-down positioning led to a reduction in the rate of postoperative retinal displacement in comparison with support-the-break positioning (42% vs 58%), although no difference in visual acuity or distortion was found.

    Meaning  Findings of this study suggest that face-down positioning reduces retinal displacement after macula-involving retinal detachment repair.


    Importance  A lack of consensus exists with regard to the optimal positioning regimen for patients after macula-involving retinal detachment (RD) repair.

    Objective  To evaluate the effect of face-down positioning vs support-the-break positioning on retinal displacement and distortion after macula-involving RD repair.

    Design, Setting, and Participants  A prospective 6-month single-masked randomized clinical trial was conducted at a multicenter tertiary referral setting from May 16, 2016, to May 1, 2018. Inclusion criteria were fovea-involving rhegmatogenous RD; central visual loss within 14 days; patients undergoing primary vitrectomy and gas surgery, under local anesthetic; patients able to give written informed consent; and 18 years old and older. Analysis was conducted following a modified intention-to-treat principle, with patients experiencing a redetachment or failure to attach the macula being excluded from analysis.

    Interventions  Participants were randomized 1:1 to receive face-down positioning or support-the-break positioning for a 24-hour period postoperatively. Positioning compliance was not monitored.

    Main Outcomes and Measures  The proportion of patients with retinal displacement on autofluorescence imaging at 6 months postoperatively. Secondary outcomes included proportion of patients with displacement at 2 months; amplitude of displacement at 2 and 6 months; corrected Early Treatment Diabetic Retinopathy Study visual acuity; objective Distortion Scores; and quality of life questionnaire scores at 6 months.

    Results  Of the 262 randomized patients, 239 were analyzed (171 male [71.5%]; mean [SD] age, 60.8 [9.8] years). At 6 months, retinal displacement was detected in 42 of 100 (42%) in the face-down positioning group vs 58 of 103 (56%) in the support-the-break positioning group (odds ratio, 1.77; 95%CI, 1.01-3.11; P = .04). The degree of displacement was lower in the face-down group. Groups were similar in corrected visual acuity (face-down, 74 letters vs support-the-break, 75 letters), objective D Chart Distortion Scores (range: 0, no distortion to 41.6, severe distortion; with face-down at 4.5 vs support-the-break at 4.2), and quality of life scores (face-down 89.3 vs support-the-break 89.0) at 2 and 6 months. Retinal redetachment rate was similar in both groups (face-down group, 12.2% and support-the-break group, 13.7%). Retinal folds were less common in the face-down positioning group vs the support-the-break positioning group (5.3% vs 13.5%, respectively; odds ratio, 2.8; 95% CI, 1.2-7.4; P = .03). Binocular diplopia was more common in the support-the-break group compared with the face-down positioning group (7.6% vs 1.5%, respectively; odds ratio, 5.3; 95% CI, 1.3-24.6; P = .03). Amplitude of displacement was associated with worse visual acuity (r = −0.5; P < .001) and distortion (r = 0.28; P = .008).

    Conclusions and Relevance  In this study, findings suggest that face-down positioning was associated with a reduction in the rate and amplitude of postoperative retinal displacement after macula-involving RD repair and with a reduction in binocular diplopia. No association was found with visual acuity or postoperative distortion.

    Trial Registration  ClinicalTrials.gov Identifier: NCT02748538