Retinal detachment surgery - improving outcomes
1 March 2021
Moorfields researchers Professor David Charteris, Mr Edward Casswell and colleagues have been funded by the charity to carry out research to improve outcomes for patients with retinal detachment.
In a paper, published in JAMA Ophthalmology, they report on their investigations on the positioning of patients after retinal detachment surgery. They found that positioning patients in a face down position was associated with improved post-operative outcomes.
1 in 10,000
People have a retinal detachment each year
Percentage of retinal detachments can be repaired with a single intervention
Retinal detachment surgery has a high success rate but after the operation patients can experience retinal displacement, which is movement of the retina. There can also be changes in visual acuity, double vision or distorted vision. One method which is used to reduce the risk of this is to ask patients to lie in certain positions after the surgery – or post-operative positioning.
Retinal detachment surgery
Retinal detachment is treated through surgery to seal retinal holes and reattach the retina. A vitrectomy is one form of operation which involves creating small openings in the eye, removing some of the vitreous inside and using lasers or freezing to fix the break. Then a gas or silicone oil bubble is inserted into the eye to support the retina while it heals. This bubble will float into the best position to support the retina.
There has previously been a lack of consensus between surgeons about the best positioning with few, robust studies or randomised trials. Some surgeons will recommend face-down positioning while others opt for alternative regimens, including ‘support-the-break’ positioning, which depends on the specific location of the retinal tear.
Investigating the best way to position patients
With funding from Moorfields Eye Charity, Professor David Charteris and Mr Edward Casswell, with colleagues from the Tennent Institute of Ophthalmology in Glasgow, carried out a randomised trial on patient positioning following surgery for retinal detachment. The study investigated if one positioning regimen was more effective at reducing retinal displacement and distortion after surgery.
Patients were included in the study if they were having an operation called a vitrectomy to fix retinal detachment. The patients were randomly assigned to either face down positioning or support-the-break positioning for the 24 hours after the operation. The patients were then followed up for 6 months afterwards to look for differences in various measures.
The benefits of face down positioning
The study showed that face down positioning was associated with both structural and functional benefits. Imaging demonstrated that the face down group had a reduced rate of retinal displacement and when it did occur, the amplitude of the displacement was smaller.
Face-down positioning also reduced the number of patients who experienced binocular diplopia, which is double vision. Previous studies have demonstrated that binocular diplopia can significantly affect patients’ quality of life so this finding is important when surgeons consider the aftercare regimes for patients.
The findings of this study will allow other ophthalmologists and surgeons to take into account these aspects when recommending positioning after vitrectomy surgery.
Retinal displacement- how best to detect it?
In a more recent publication, Mr Edward Casswell reports on further research the team have been conducting. In their article in Ophthalmologica, their study focused on the reported incidence of post retinal detachment macular displacement. This is when a part of the retina called the macula moves after surgery. The macula is responsible for our central vision and has a high number of the cells that detect light.
The reported incidence of post retinal detachment macular displacement varies greatly and it is unclear whether the methods used to image the eye are contributing to this reported variability. In this study they compared two imaging approaches - fundus autofluorescence and confocal scanning laser ophthalmoscope (cSLO).
They found no difference in the detection rates of retinal displacement using the more readily available cSLO autofluorescence imaging, which should allow more researchers to investigate this phenomenon.