Macula-off retinal detachments fare best when corrected within 2–3 days

This comprehensive Japanese study found that repairing retinal detachment within 2 days of onset resulted in significantly better postoperative visual acuity than surgery performed up to 3 days later; visual benefits stagnated if surgery was delayed by 4 or more days.

Study design

This prospective observational cohort study analyzed 719 eyes with macula-off rhegmatogenous retinal detachments (RRD) registered with the Japan-Retinal detachment registry. The goal of the analysis was to evaluate the association between the duration of macular detachment (DMD) and visual prognosis assessed 6 months postoperatively.

Outcomes

Surgeries performed within 2 days after the onset of macular detachment showed significantly better visual acuity 6 months postoperatively as compared to those performed 3 days after onset. Similarly, surgeries performed within 3 days yielded better outcomes than those performed after 4 days. In contrast, there were no significant differences in visual outcome between surgeries performed at 4, 5, or 6 days after macular detachment.

Limitations

A major limitation of this study is its observational nature. In addition, the study relies on patient report of loss of vision to calculate DMD.

Clinical significance

Similar to other recently published studies, the current analysis demonstrates a benefit to performing macula-off detachment surgery sooner than the original teaching recommendation of within 1 week. This study shows that prompt surgery within 2 days of macular detachment leads to the best visual outcomes, as compared to 3 or 4 days post-detachment, and that no difference in visual acuity was noted between repairs performed 4 to 6 days later. However, a balance needs to be established between the push to perform surgery sooner and the availability of experienced operating room teams and resources.

Financial Disclosures: Dr. Lisa Schocket discloses no financial relationships.