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  • Time before repair of rhegmatogenous retinal detachment impacts visual acuity

    Retina/Vitreous

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    Review of: Impact of the time to surgery on visual outcomes for rhegmatogeous retinal detachment repair: A meta-analysis

    Sothivannan A, Eshtiaghi A, Dhoot A, et al. American Journal of Ophthalmology, December 2022

    Visual acuity outcomes after rhegmatogenous retinal detachment (RRD) repair appear linked to the timing between symptom onset and surgery, with better results seen if repair occurs within 24 hours of macula-on RRD or within 3 days of macula-off RRD presentation.

    Study design

    This meta-analysis included 19 cases series and 2 cohort studies with a total of 1929 eyes at baseline. Due to data limitations, the analysis assessed time from symptom onset to rhegmatogenous retinal detachment (RRD) repair for macula-off RRDs and time from initial presentation to repair for macula-on RRDs.

    Outcomes

    Macula-off RRD repair within 0–3 days of symptom onset achieved superior final best-corrected visual acuity (BCVA) outcomes than repair within 4–7 days. Similarly, repair of a macula-on RRD within 0–24 hours of presentation led to improved BCVA outcomes as compared to those repaired after 24 hours.

    Limitations

    A major limitation is the analysis of observational studies that were of low-to-moderate quality. These studies had small sample sizes and were retrospective in design. In addition, it is unclear whether confounders were effectively controlled across studies. Reporting inconsistencies also led to an inability to assess whether type of surgical repair, lens status, or endotamponade had an effect on the final BCVA.

    Clinical significance

    Macula-off RRD repair within 3 days of symptom onset may have superior final BCVA as compared to repair within 4–7 days. Similarly, macula-on RRD that is repaired within 24 hours of presentation may provide superior VA outcomes than if repair is delayed beyond 24 hours. However, these conclusions must be interpreted in the context of being based on studies of moderate-to-low quality. In addition, the timing of surgery can be influenced by surgical-team availability, especially since many of these cases are done in ambulatory surgicenters with limited hours of operation. This information is helpful for surgical timing of RRD repair, but the information needs to be used in the context of available resources.

    Financial Disclosures: Dr. Schocket discloses no financial relationships.