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Danielle S. Strauss, Tahsin Choudhury, Christopher Baker, Shantan Reddy; Visual Outcomes After Primary Repair of Chronic Versus Super-Chronic Macula-Off Rhegmatogenous Retinal Detachments In An Underserved Population. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6139.
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It has been previously reported that the chronicity of a rhegmatogenous retinal detachment (RRD) is a negative prognostic factor for anatomic success and visual improvement following surgical repair. Previous studies have not compared visual acuity outcomes in patients who underwent pars plana vitrectomy for repair of chronic (>14 days-3 months) RRDs with patients who underwent the same procedure for super-chronic detachments (>3 months old).
A total of 12 eyes with macula-off RRDs which underwent pars plana vitrectomy, with or without scleral buckling were studied. The eyes were divided into two groups based on time from presentation of symptoms to surgery. "Chronic" retinal detachment was defined as greater than 2 weeks (range 15-50 days), and "Super-Chronic" retinal detachment was defined as greater than 3 months duration (range 97-3650 days). LogMar best corrected visual acuity (BCVA) was compared pre-operatively and at the 3 month post-operative visit. Retinal detachments with greater than grade A PVR and those that needed silicone oil placement were excluded.
Twelve eyes had repair of a retinal detachment with a mean time from symptoms to surgery of 32.7 days (SD ±14.1) in the chronic group, and a mean time of 842.2 days (SD ±1404.1) in the super-chronic group, P = 0.19. The mean pre-operative BCVA was not statistically different between the chronic group and the super-chronic group (2.0 (SD±1.0), vs 1.4 (SD±1.1), P=0.37). At the 3 month post-surgical follow-up visit, the LogMAR BCVA was also not statistically significant between the two groups with BCVA of 1.5 (SD ±0.9) in the chronic group and 0.9(±0.6) in the super-chronic group, P=0.29. A similar mean gain in BCVA in both groups was observed. The chronic group gained 0.5 (SD ±0.4) and the super-chronic gained 0.4 (SD ±0.5), P=0.84.
We found that repairing super-chronic RRDs over three months old can improve visual acuity and in fact visual recovery may not be significantly different from chronic RRDs that have not been detached for as long. This suggests that the speed of photoreceptor loss that occurs with retinal detachments may begin to slow with time. Clinicians should be aware of the benefit of repairing long-standing RRDs which are not uncommon in the underserved population, weighing the desire to operate quickly against the benefit of delaying surgery to have the optimal team and facilities on hand in a county hospital setting.
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