One Year Visual Outcomes For Macula-off Rhegmatogenous Retinal Detachment

Abstract

Purpose: : To report the one year visual outcome of a multi-centre prospectively recruited cohort of macula-off rhegmatogenous retinal detachments (RD) from Scotland.

Methods: : The Scottish retinal detachment study was a two year prospectively recruited study that recruited all incident cases of primary RD in Scotland over a two year period (2007-2009). All patients with a macula off RD from four participating sites were invited for clinical examination at 6 weeks, 3 months, 6 months and 1 year after the initial surgery. Data was collected on duration of detachment, best corrected visual acuity (VA) and duration and instruction of post operative posturing. Using categorical parametric testing, we divided participants into several groups (pseudophakic, duration of detachment > 1 week, bullous RD and instruction to posture postoperatively) and analysed the visual outcome over four time intervals.

Results: : After exclusion of patients with incomplete data/previous retinal pathology/lost to follow up (N=290), multiple RD repair (N=16), those with long term silicone oil in situ (N=5) and those with visual significant cataract (N=11), there remained 291 patients with primary macula off RD with no pre-existing retinal disease that had successful repair after one operation. Overall, 53.8% (N=156) had an improvement of at least 0.1 logMAR units between first and final follow up. The median number of days the macula was detached for was 5 (IQR 2-14). The overall mean visual acuity increased from 0.86 logMAR at 6 weeks to 0.57 logMAR at one year (p<0.001). This was highly significant for phakic RD and a similar but insignificant trend was noted for pseudophakic RD. Macula off RD of ≤ 7 days duration had a significant improvement in visual acuity at each post operative visit up to one year. (p<0.001) Macula off RD of greater than 7 days demonstrated an initial improvement in VA at 3 months with no significant improvement at subsequent visits. Both bullous and bisected RD continued to have an improvement in visual outcome up to one year postoperatively. Posturing post operatively was similarly associated with a continuing visual improvement up to one year.

Conclusions: : The majority of individuals with macula-off RD have an improvement in VA of at least 0.1 logMAR at one year. Macula off RD of less than one week duration is more likely to demonstrate a continuing improvement in VA one year postoperatively compared to macula off RD of more than one week duration.

Keywords: retinal detachment • clinical (human) or epidemiologic studies: outcomes/complications