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PurposeTo determine if final visual acuity (VA) is affected by duration of macular detachment (DMD) within the first week of macula-off retinal detachment (RD).MethodsThis is a retrospective study of eyes that underwent repair within 7 days with vitrectomy or vitrectomy with scleral buckle for macula-off RD at Stanford University Hospital between 1 May 2007 and 1 May 2017. A generalised linear model was constructed using DMD, postoperative lens status, preoperative VA, patient age and surgeon as the independent variables and the final VA as the dependent variable. The main outcome measure was the final VA.ResultsSeventy-nine eyes met the entry criteria. Group 1 included 52 eyes with RD repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD. The average final VA in group 1 eyes was logarithm of the minimum angle of resolution (logMAR) 0.21 (Snellen 20/33) and in group 2 eyes was logMAR 0.54 (Snellen 20/69). In group 1 and group 2 eyes, preoperative VA (p=0.017and p=0.007), DMD (p=0.004 and p=0.041) and final lens status (p<0.0001 and p<0.001) predicted postoperative VA. Post-hoc analysis showed significant differences in final VA between detachments of 1day vs 3 days (p=0.0009).ConclusionDMD affects the final VA even among patients whose DMD is <3 days. Based on these results, interventions that shorten DMD, including those occurring within the first 3days, may result in improved long-term VA outcomes.

pigment epithelial atrophy, the patient was managed conservatively. Follow-up at 4 months showed spontaneous resolution of the subretinal fluid on optical coherence tomography (Figure 1C); visual acuity had returned to 6/60 OS but the macular hole remained open. Four months later, the patient's vision remained stable but the subretinal fluid had returned. An inverse pseudohypopyon was visible at the macula (Figure 2), and optical coherence tomography now demonstrated the presence of droplet-like particles suggestive of emulsified silicone oil (Figure 1D). The patient declined further intervention. Posturing did not appear to affect the distribution of the oil. Comment. Silicone oil is a commonly used intraocular tamponade in the surgical management of giant retinal tear. Subretinal silicone oil is a rare but serious complication that can result in loss of internal tamponade and subsequent failure of retinal detachment repair. Silicone oil can migrate into any open retinal break, particularly if the surrounding retina is detached. The delayed presentation of subretinal silicone oil has been described in cases of retinal detachment associated with optic disc pit. 4 We believe that this is the first description of emulsified submacular silicone oil presenting as an inverse pseudohypopyon. It is unclear when the macular hole formed and therefore whether the emulsified silicone oil passed through a newly formed macular hole into the subretinal space or whether subretinal silicone oil migrated to the posterior pole over time. It is possible that emulsification along the posterior oil interface may have allowed tiny droplets to enter the hole, thereby contributing to retinal detachment. Recent imaging studies have observed that silicone oil can pass through an open macular hole under certain postural conditions. 5 It is interesting to note that the level of visual acuity is relatively well preserved despite the possibility that the oil might have been present in the subretinal space for many years. We postulate that the spontaneous accumulation and resolution of submacular fluid suggest a dynamic process whereby the emulsified oil might act to intermittently close the macular hole, allowing the retinal pigment epithelial pump to clear the fluid when an effective seal is present. We do not have any images to confirm this. This case demonstrates a novel clinical entity that raises further questions about how silicone oil can behave within the eye.