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Margaret Greven, Theodore Leng, Loh-Shan Leung, Darius M. Moshfeghi, Steve Sanislo, Ruwan Silva, Ira Schachar; Progressive Reductions in Acuity Occur even within the First Three Days After a Macula-Off Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1159.
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The effect of surgical timing on the outcome of macula-off retinal detachments has long been the subject of investigation. Though initial studies showed no effect of delays in surgical intervention for up to 7 days, more recent studies have demonstrated that after 3 days, there is progressive loss of final visual acuity, and animal work shows progressive damage beginning at 24 hours. We therefore hypothesize that progressive reductions in final visual acuity occur during the first three days of macula involving retinal detachment
An IRB-approved retrospective review of all eyes that underwent repair for retinal detachment at Stanford University Hospital between 5/1/2007 and 5/1/2017. Patients were included in the analysis if they had a macula-off retinal detachment with duration of 7 days or less at the time of surgery, had no proliferative vitreoretinopathy or other significant ocular pathology, underwent vitrectomy or combined vitrectomy with scleral buckle, and had single operation success. Patients were split into two groups based on duration of detachment at time of surgery, Group 1 (< 3 days) vs Group 2 (4-7 days). A generalized linear model was constructed using the duration of retinal detachment, lens status, preoperative visual acuity, age of patient, and surgeon as independent variables and final visual acuity as the dependent variable.
Seventy-nine patients met entry criteria. Group 1 (< 3 days) consisted of 52 of the 79 patients, with a mean visual acuity at presentation of LogMAR 1.39 + 0.98 (Snellen 20/490). Group 2 (4-7 days) consisted of 27 of the 79 whom had a mean visual acuity of LogMAR 1.76 + 1.02 (Snellen 20/1150). Among both Group 1 and Group 2 patients, preoperative visual acuity (p=0.017 and p=0.007), total duration of maculardetachment (p=0.004 and p=0.041), and final lens status (p<0.0001 and p<0.001) predicted postoperative visual acuity. Post-hoc analysis showed significant differences between macula involving retinal detachments of 1 day versus 3 days (p=0.0009).
Our study indicates that the duration of detachment affects final visual acuity even when duration of detachment is less than 3 days. Based on these results, interventions that shorten the duration of the macula-off retinal detachment, including those occurring within the first three days, may result in improved long-term visual acuity outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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