Abstract
Purpose :
To examine the effect of time to surgical repair on post-operative visual acuity in order to establish an evidence-based standard of care for the repair of macula-involving rhegmatogenous retinal detachment.
Methods :
Retrospective chart review was conducted for patients who underwent surgical repair of a macula-involving rhegmatogenous retinal detachment at two ophthalmology services from 2008 to 2019. Exclusion criteria were post-operative best corrected visual acuity (BCVA) worse than 20/30 before detachment, recurrent detachments, and patients without adequate follow-up. Multivariate linear and logistic regression models were constructed using eyes with a known duration of macular detachment. The primary outcome measure was post-operative BCVA as dependent on duration of macular detachment.
Results :
Three hundred forty eyes from 340 patients met inclusion criteria; 277 eyes had a known duration of macular detachment and were included in linear and logistic regression models. Surgical repair occurred an average of 7.5±8.8 days following macular detachment (range 0 to 76). Mean post-operative BCVA was logMAR 0.15 (95% CI, 0.13 to 0.18) in eyes with 3 or fewer days of macular detachment, and mean post-operative BCVA was logMAR 0.28 in eyes with 4 or more days of macular detachment (95% CI, 0.24 to 0.33; difference, logMAR –0.13; P < 0.001). Post-operative BCVA increased by 0.007 logMAR units with each additional day of macular detachment (P < 0.001). One hundred of 108 eyes (92.6%) that underwent surgical repair within 3 days of macular detachment had post-operative BCVA of logMAR 0.30 or better (Snellen 20/40), compared to 123 of 169 eyes (72.8%) who had surgical repair after 4 or more days of macular detachment (OR 0.21; 95% CI, 0.097 to 0.474; P < 0.001). For each additional day of macular detachment, the odds of achieving logMAR 0.30 decreased by a factor of 0.93 (95% CI, 0.89 to 0.96; P < 0.001). Pre-operative vision and duration of macular detachment were associated with post-operative BCVA; patient age, surgical eye, and lens status did not significantly affect post-operative BCVA.
Conclusions :
Longer duration between macular detachment and repair is associated with a progressive decline of post-operative visual acuity. Surgical repair within 3 days of macular detachment improves visual acuity outcomes and should be the standard of care for macula-involving rhegmatogenous retinal detachments.
This is a 2021 ARVO Annual Meeting abstract.