Repairing macula-off retinal detachment early yields better visual outcomes

This study reports better one-year visual outcomes when macula-off retinal detachments are repaired within eight days. While this is not new information, few studies have evaluated this in the United Kingdom, where this study was conducted, and these results are consistent with what has previously been reported.

The study included 291 patients with primary macula-off rhegmatogenous retinal detachments and no pre-existing retinal disease. They were enrolled in the two-year, multicenter, Scottish retinal detachment study and all achieved successful repair after one operation. They were examined at six weeks, three months, six months and one year after surgery. Sixty-six percent achieved a final visual acuity (VA) of 0.48 logMAR (6/18) or better.

The authors found a strong linear relationship between final cumulative mean VA and duration of macular detachment. Patients with macular detachment of eight days or less demonstrated a significant improvement in VA at each follow-up visit, with a trend continuing for up to one year, suggesting that early surgical intervention may be beneficial for long-term visual outcome. However, patients whose surgery was delayed longer than eight days failed to show significant improvement in vision after the first postoperative visit at six weeks.

The authors note that patients with macula-off retinal detachment of greater than eight days were more likely to have had cataract surgery and more often presented with a shallow macular detachment, features that are likely to influence the longer time to presentation in this group.

The study's findings suggest not only that the longer the macula is detached the worse the final visual outcome, but also that a longer duration of detachment reduces the potential for long-term visual gain.