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  • Macula-off retinal detachment may be more urgent than previously thought

    Retina/Vitreous

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    This study examines whether final visual acuity (VA) is influenced by the duration of macular detachment.

    Study design

    Researchers analyzed data from eyes with macula-off retinal detachment (RD) that underwent vitrectomy with or without scleral buckling within 7 days after the onset of a presumed macular detachment. The authors accounted for the duration of macular detachment, postoperative lens status, preoperative visual acuity, patient age and surgeon experience.

    Outcomes

    The analysis included 79 eyes with a mean follow-up period of 19.6 months. Group 1 (52 eyes) underwent RD repair within 3 days of macular detachment while Group 2 (27 eyes) had surgery within 4 to 7 days of macular detachment. Final VA was better in Group 1 than in Group 2 (20/33 vs. 20/69). Within Group 1, final VA was best in eyes with the shortest duration of macular detachment (P=0.0009).

    Limitations

    As with any retrospective study, there are concerns about uncontrolled differences between the groups. The height of macular detachment was not measured and has previously been shown to play a role in visual outcomes. There was also variable follow-up, ranging from 2 to 105 months. A shorter follow-up time may not have adequately illustrated the full visual recovery after a macula-off RD. It is sometimes hard to pinpoint the timing of the macular detachment, as the authors relied on patient reporting of their symptoms. With visual acuity as the outcome, it does not appear that protocol refractions were performed in patients, which may have further affected the accuracy of visual acuity measurement.

    Clinical Significance

    Past studies have come to inconsistent conclusions about the timing of repair for macula-off RDs. Some studies have suggested no difference in outcomes if the RD is repaired within a week of macular detachment. However, it makes sense that the macular photoreceptors may sustain increasing damage the longer those cells are separated from their normal anatomic position, with a potential for ischemia. This study suggests clinicians should rethink the conventional teaching that a macula-off RD is not an emergency situation, as the authors found a difference in visual outcomes when surgery was performed 1 versus 3 days after macular detachment.