The use of positioning and head exercises to unfold the inverted edge of a giant retinal break has been reported briefly.1 The inverted retinal flap of a superior giant break may unfold when the patient's head is lowered, as in the Trendelenburg position. In cases where complete unfolding is not accomplished with positioning, the addition of head exercises may achieve the desired result.
Positioning and exercises generally are less effective when the patient is supine. They can be very effective when the patient is prone because the vitreous gel moves away from the inverted retinal flap and does not impede its unfolding.
Once the retinal flap has unfolded, incarceration of the retina behind the posterior edge of the giant break before scleral buckling seems to be the best method of preventing reinversion and redetachment. It is necessary to incarcerate the retina with the patient in the most favorable position
SCHEPENS CL, FREEMAN HM, THOMPSON RF. A Power-Driven Multipositional Operating Table. Arch Ophthalmol. 1965;73(5):671–673. doi:10.1001/archopht.1965.00970030673016
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