In the absence of PVR, the overall rate of primary anatomical reattachment with current techniques is 80%–90% for the primary surgery. The exact rate depends on technique and preoperative ocular findings. In patients with PVR or who have had previous reattachment surgeries, success rates are in the 70% range. However, rates for final reattachment, even if multiple procedures are required, are in the 90%–100% range. Retinal detachments caused by dialyses or small holes or that are associated with demarcation lines have a better prognosis. Aphakic and pseudophakic eyes have a slightly less favorable prognosis. Detachments caused by giant tears or that are associated with PVR, uveitis, choroidal detachments, or posterior breaks secondary to trauma have the worst prognosis for anatomical reattachment.
Sullivan P. Techniques of scleral buckling. In: Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P, eds. Ryan’s Retina. Vol 3. 6th ed. Philadelphia: Elsevier/Saunders; 2018.
Postoperative visual acuity
The status of the macula—whether it was detached and for how long—is the primary presurgical determinant of postoperative visual acuity. If the macula was not detached (“macula-on” retinal detachment) and the retinal detachment is successfully repaired, restoration of preoperative visual acuity is usually expected. However, 10%–15% of these eyes do not return to preoperative visual acuity.
If the macula was detached preoperatively (“macula-off ” retinal detachment), damage to—or degeneration of—photoreceptors may prevent good postoperative visual acuity. Only approximately one-third to one-half of eyes with a detached macula recover visual acuity to the level of 20/50 or better. Among patients with a macular detachment of less than 1 week’s duration, 75% will obtain a final visual acuity of 20/70 or better, as opposed to 50% with a macular detachment of a duration exceeding 7–10 days but shorter than 8 weeks.
In addition to photoreceptor damage from the detachment, factors associated with visual acuity deterioration or incomplete recovery following successful retinal reattachment surgery include irregular astigmatism, cataract progression, persistent subfoveal fluid, macular edema, or macular pucker. Intraoperative complications such as hemorrhage and preexisting ocular pathology may also limit visual recovery.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.