Abstract
Purpose :
Macular involvement is often reported as a poor prognostic factor of rhegmatogenous retinal detachments (RRD). Although patients who undergo RRD repair are reported to reach stable vision 3-6 months after surgery, few studies report visual outcomes longer than 2 years after repair of macula-off RRD with pars plana vitrectomy (PPV), the current preferred method of repair. The purpose of this study is to evaluate visual outcomes of fovea-involving RRD repair with PPV or combined PPV/scleral buckle (SB) in eyes with at least 5 years of post-operative data.
Methods :
This retrospective case series evaluated eyes that underwent fovea-involving RRD repair with PPV or PPV/SB at the Cole Eye Institute. Eyes with single operation anatomic success and 5 years or more of follow-up were included. Eyes with other ophthalmic pathology affecting central vision were excluded. Best visual acuity (BVA) was measured in Snellen visual acuity and converted into Early Treatment Diabetic Retinopathy Study (ETDRS) score. Paired t-test analysis compared changes in BVA between two time-points. Multiple linear regression analyses evaluated the impact of age, lens status at baseline, and pre-operative BVA on final BVA and total gain in BVA.
Results :
51 eyes were included. Mean time to final follow-up was 6.55±1.38 years. Mean pre-operatively BVA was 21.47±23.20 (~20/400) and improved to 72.72±16.52 (~20/32) and 78.14±10.16 (~20/25) at the 1-year and final follow-up, respectively (p<0.001). Thirteen of 45 eyes (28.89%) had an improvement in BVA of at least 10 letters from the 1-year to the final follow-up. Mean 1-year BVA was significantly different from final BVA (p=0.002). Average BVA was 20/40 or better in 35/45 eyes (75.56%) at 1-year and 45/51 eyes (88.24%) at final follow-up. Average BVA was 20/200 or worse in 1/51 (1.97%) eyes at final follow-up. In regression analysis, a greater total gain in BVA was associated with a lower pre-operative BVA (p<0.001) but not with age or lens status. In linear regression, no parameter correlated with final BVA.
Conclusions :
Patients with fovea-involving RRD successfully repaired with PPV or PPV/SB have favorable long-term visual acuity outcomes. BVA may continue to significantly improve even beyond 1 year after surgery, and the majority of patients have a BVA of 20/40 or better 5 years after surgery.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.