Effect of Duration of Macular Detachment on Visual Prognosis after Surgery for Macula-Off Retinal Detachment

Miyake, Masahiro; Nakao, Shinya; Morino, Kazuya; Yasukura, Shota; Mori, Yutaka; Ishihara, Kenji; Muraoka, Yuki; Miyata, Manabu; Tamura, Hiroshi; Sakamoto, Taiji; Tsujikawa, Akitaka

doi:10.1016/j.oret.2023.01.014

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…These findings are consistent with a growing body of literature that challenges the conventional approach to the timing of RD repair. [2][3][4][5][6][7][8][9][10] The average final VA did not decline significantly based on the length of time to surgery in the fovea-on group in this study in which almost 95% of such cases underwent surgical repair within three days. Wykoff et al 3 reported VA outcomes in 199 patients with fovea-on RDs-33% of whom had extension of subretinal fluid within the macular arcade vessels at presentation-and found similar results.…”

Section: Discussionmentioning

confidence: 49%

“…These findings are consistent with a growing body of literature that challenges the conventional approach to the timing of RD repair. 2–10…”

Section: Discussionmentioning

confidence: 99%

“…23,24 In addition, results from several recent clinical studies of fovea-off RDs ranging from retrospective case series to meta-analyses suggest that vision outcomes are better if surgery is performed within one to three days of foveal detachment. [5][6][7][8][9][10] Yorston et al 8 studied 2074 macula-off RD cases derived from a prospective British database and found that the most important modifiable risk factor for a poor VA outcome was the patient-reported duration of central vision loss. Based on their findings, the authors recommended that recent macula-off RDs be repaired within 72 hours of central vision loss.…”

Section: Discussionmentioning

confidence: 99%

“…1 By contrast, results from more recent reports have challenged this paradigm. [2][3][4][5][6][7][8][9][10] From the standpoint of maximizing visual acuity (VA) outcomes, these studies suggest that appropriate macula-on cases may not require emergent intervention and macula-off cases may benefit from earlier repair.…”

mentioning

confidence: 99%

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Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment

Haq,

Mittra,

Parke

et al. 2023

Retina

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Purpose: To investigate the impact of surgical timing on visual acuity (VA) outcomes in retinal detachments (RD) based on preoperative foveal status. Methods: A retrospective multicenter cohort study was conducted. Cases were stratified into fovea-on, fovea-split, and fovea-off groups. Days to surgery was defined as the time between the preoperative examination and surgery. The main outcome measure was final postoperative VA. Results: 1675 cases were studied. More than 80% of fovea-on/fovea-split and fovea-off cases had surgery within 1 and 3 days, respectively. The mean final postoperative VA did not differ significantly between the fovea-on and fovea-split groups (SE 20/33 ± 20/49 and 20/32 ± 20/39, p = 1.000) and did not change significantly based on days to surgery in either group. The mean final postoperative VA was lowest in the fovea-off group (Snellen equivalent [SE] = 20/56 ± 20/76, p < 0.001) and was significantly lower in cases where surgery was performed after 2 or more days when compared to cases performed within 1 day (SE 20/74 ± 20/89 vs 20/46 ± 20/63, p < 0.001). Conclusions: Fovea-on and fovea-split RDs demonstrated comparable visual outcomes. Fovea-off RDs demonstrated worse visual outcomes, which declined further when surgery was delayed by 2 or more days.

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Section: Discussionmentioning

confidence: 49%

“…These findings are consistent with a growing body of literature that challenges the conventional approach to the timing of RD repair. 2–10…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment

Haq,

Mittra,

Parke

et al. 2023

Retina

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“…6 There is increasing evidence that macula-off RRD treated within 72 hours from the loss of the central vision seemed to have better visual outcomes than those treated after a longer interval. 6,9,10 However, a progressive recovery of vision after successful macula-off RRD repair has been previously reported. 7,11–13 In fact, visual acuity may continue to improve for up to 10 years after surgery in macula-off RRD.…”

mentioning

confidence: 99%

The long-term recovery of vision in pseudophakic macula-off rhegmatogenous retinal detachments.

Moussa,

Jalil,

Lippera

et al. 2023

Retina

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Purpose: To assess the long-term visual recovery in uncomplicated macula-off pseudophakic rhegmatogenous retinal detachment (PRRD) treated with pars plana vitrectomy (PPV) and gas tamponade in the absence of other visual co-morbidities. Methods: Single-centre retrospective longitudinal study on eyes with macula-off PRRD successfully treated with PPV between 2011 and 2020 and with at least two follow-ups (FU), first gas-free FU (first-FU) and a final FU, were included. Patients with subsequent ocular surgery or comorbidities affecting BCVA were excluded. The duration between operation date and final-FU was calculated (total days FU [TD]) and split into TD-quintiles: 1:≤57, 2: >57 and ≤77, 3:>77 and ≤152, 4:>152 and ≤508 and 5:>508 days. Multivariable regression was performed with logMAR gain between first and final-FU as the dependent variable. Results: In 209 eyes, we report association with increase of logMAR gain between first and final-FU, with reducing clock-hours of PRRD (p=0.041) and relative to the TD-quintile 1. Mean (standard deviation) LogMAR gain between first and final follow-up was 0.02 (0.07) in the first quintile, increasing to 0.14 (0.13) (p<0.001) by fifth quintile on multivariable regression. For patients not achieving 0.30 logMAR at first-FU, this was attained at final-FU with a sensitivity of 51.9% and specificity of 95.5% at a cut off ≤0.58 logMAR at first-FU (AUC 0.756 [95%CI 0.664 to 0.848], p<0.001) Conclusions: We report a significant time-dependent visual improvement after uncomplicated PPV with gas tamponade for macula-off PRRD without visual confounders, and provide important quantitative data for counselling patients with macula-off repair.

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Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

Ong,

Tran,

Westlund

et al. 2024

JAMA Ophthalmol

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ImportanceFunctional outcomes after repair of rhegmatogenous retinal detachments (RRDs) are highly dependent on baseline visual acuity and foveal status. Adverse social determinants of health (SDOH) can present barriers to timely presentation for repair and limit vision outcomes.ObjectiveTo evaluate the association between neighborhood-level SDOH with baseline severity (visual acuity and fovea status) of RRD.Design, Setting, and ParticipantsThis was a retrospective cohort study that included adult patients 18 years and older who underwent primary repair of uncomplicated RRD at the Wilmer Eye Institute from January 2008 to December 2018. Study data were analyzed from December 2023 to April 2024.ExposuresThe census block group of patient home addresses were matched to multiple neighborhood-level SDOH including the Area Deprivation Index (ADI), per capita income, percentage of renters, percentage of rent burden, percentage of people using a food assistance program, percentage of uninsured individuals, mode of transportation to work, distance to the nearest transit stop, total road density, National Walkability Index, Index of Medical Underservice score, and aggregate cost of medical care.Main Outcomes and MeasuresOdds of presenting with vision worse than 20/40 or fovea-involving RRD using multivariable logistic regression adjusting for age, sex, race and ethnicity, and insurance.ResultsA total of 700 patients (mean [SD] age, 57.9 [12.4] years; 432 male [61.7%]) were included. Every decile increase in ADI, indicating more socioeconomic disadvantage, was associated with an increased odds of presenting with worse visual acuity and fovea-involving RRD (odds ratio [OR], 1.14; 95% CI, 1.04-1.24; P = .004 and OR, 1.13; 95% CI, 1.04-1.22; P = .005, respectively). Each $1000 increase in per capita income was associated with lower odds of presenting with worse vision (OR, 0.99; 95% CI, 0.98-0.99; P = .001). Every 1% increase in percentage of workers who drove to work was associated with an increased odds of presenting with worse vision and fovea-involving RRD (OR, 1.02; 95% CI, 1.01-1.03; P = .005 and OR, 1.01; 95% CI, 1.00-1.03; P = .04, respectively).Conclusions and RelevanceResults of this cohort study suggest that patients with a residence in neighborhoods with more socioeconomic deprivation or a higher percentage of workers who drove to work were more likely to present with more severe RRD even after accounting for multiple individual-level characteristics. These findings support consideration of public policy changes to address the barriers faced by patients residing in certain neighborhoods who seek prompt surgical intervention for RRD to reduce health disparities in RRD outcomes.

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Effect of Duration of Macular Detachment on Visual Prognosis after Surgery for Macula-Off Retinal Detachment

Cited by 8 publications

References 26 publications

Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment

Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment

The long-term recovery of vision in pseudophakic macula-off rhegmatogenous retinal detachments.

Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

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