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C. C. Wykoff, W. E. Smiddy, H. W. Flynn, Jr., T. Mathen, S. Schwartz, W. Shi, J. Schiffman, W. Feuer; Macula-Sparing Retinal Detachments: Time to Surgery and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3163.
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To study the clinical issue that a macula-sparing retinal detachment is a surgical emergency by analyzing visual outcomes depending on the duration of time from presentation to surgical repair.
Clinical records were reviewed for all patients treated between 1989 and 2006 by a single surgeon for primary, macula-sparing rhegmatogenous retinal detachments. Institutional review board approval was obtained.
Primary, macula-sparing rhegmatogenous retinal detachments were diagnosed and treated by sclera buckle in 196 patients with a mean age was 54 years. In the current study, 59% of patients presented within the first week of symptoms and 84% of patients had vision of 20/40 or better at presentation. One third of retinal detachments had a posterior extent that progressed to within the macular arcade vessels without loss of central vision. 85% of patients were operated on within three days of presentation and 50% within 24 hours of presentation. One case progressed to macula-off status before surgery (0.5%). The single operation success rate was 87% and final anatomic success was achieved in all but one patient who refused reoperation. 87% of patients were followed post-operatively for at least two months, at which point 72% had achieved 20/40 or better. The strongest predictor of final vision at 2, 6 and 12 months post-operatively was presenting vision, r = 0.44, P < 0.001. There was no significant difference in final vision when surgical repair was performed within three days of presentation (P = 0.12). Furthermore, no significant correlation was found between final vision and other potential outcome predictors including time from onset of symptoms to surgical repair, location or extent of the retinal detachment, direction of the retinal detachment closest to the fovea and need for reoperation.
In the current study, progression to macula-off status was rare, occurring in 1/196 (0.5%) patients before surgical repair. Thirteen percent of patients required reoperation and 72% of patients achieved a final vision of 20/40 or better. Similar visual outcomes were achieved when surgical repair was performed within three days of presentation.
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