Abstract
Purpose :
To describe surgical indications, safety, and visual outcomes of functionally monocular patients undergoing vitreoretinal surgery.
Methods :
Retrospective case series of a multicenter surgical retina practice in Denver, Colorado. Electronic health records were reviewed from January 1st, 2017 to November 14th, 2023. Monocular patients with vision of 20/70 to 20/150 in their non-surgical eye were defined as having moderate visual impairment (MVI), while patients with 20/200 or worse visual acuity in their non-surgical eye were defined as having legal blindness (LB). Indications for surgery, complications, reoperation rates, and visual acuity (VA) were analyzed with a minimum follow up of 3 months postoperatively.
Results :
A total of 2586 vitreoretinal surgeries were performed on 2215 patients within the study period by 15 surgeons. Of these, 9 surgeons operated on a total of 61 patients (2.8%; mean age 70.02 +/- 14.53 years) who were defined as functionally monocular. Mean postoperative follow up was 6.61 months +/- 72.1 days (range: 25 - 523 days). 17 patients (27.9%) had MVI in their non-surgical eye and 44 patients (72.1%) were LB in their non-surgical eye. Most common surgical indications included intraocular lens complications (n=19), vitreous opacities (n=14), retained lens fragments (n=7), and retinal detachment (n=7). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.71 +/- 0.61 to 0.52 +/- 0.61 (P=0.03). Baseline mean logMAR VA of MVI patients (0.34 +/- 0.17) was significantly better than LB patients in their non-surgical eye (0.84 +/- 0.68) (P= 0.01). At last follow-up, mean logMAR VA for MVI patients (0.28 +/- 0.15) was significantly better than LB patients (0.72 +/- 0.83) (P=0.03). Change in VA for patients with MVI was not significantly different than LB patients (p = 0.41). No intraoperative complications were noted.16 patients (26.2%) experienced postoperative complications, 8 (13.1%) required reoperation, and 9 (14.8%) had worsened vision after surgical intervention.
Conclusions :
Functionally monocular patients undergoing vitreoretinal surgery comprise a small proportion of all surgical patients and have a low rate of reoperation. Patients with LB in their non-surgical eye present with worse baseline vision in their surgical eye and have diminished visual outcomes compared to patients with MVI.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.