Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment

Greven, Margaret A.; Leng, Theodore; Silva, Ruwan Amila; Leung, Loh-Shan B.; Karth, Peter A.; Moshfeghi, Darius M.; Sanislo, Steven R.; Schachar, Ira H.

doi:10.1136/bjophthalmol-2018-313191

Cited by 41 publications

(42 citation statements)

References 17 publications

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“…Notably, no statistically significant difference in FVA could be seen in patients who obtained surgical treatment within the first 3 days. In contrast, a more recent study by Greven et al [5] proposed a difference of FVA in patients receiving surgical intervention after a duration of 1 day of macular detachment compared to those treated after 3 days of central vision loss. However, both study groups stated that the outcome for surgical timing within the 3 days should be interpreted with great caution, as they had a low sample size of only 35 eyes.…”

Section: Discussionmentioning

confidence: 91%

“…However, the accurate timing of foveal detachment is a major limitation faced by all studies investigating surgical timing in fovea-off RRDs [1,2,5,9,10]. Most studies investigating the influence of surgical timing used patientreported beginning of central vision loss as a surrogate marker.…”

Section: Discussionmentioning

confidence: 99%

“…e duration of tolerable delay time for surgical intervention is a controversial and unresolved issue in the literature. e recommendation of maximum lag time until surgery varies from 1 to 10 days [1][2][3][4][5]. One common finding among previous studies investigating the delay of surgery is the extensive variation of FVA after repair of macula-off rhegmatogenous retinal detachment (RRD).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Timing on Visual Outcomes in Fovea-Involving Retinal Detachments Verified by SD-OCT

Angermann

Bechrakis

Rauchegger

et al. 2020

Journal of Ophthalmology

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Purpose. To investigate the impact of surgical delay after the objectivation of the foveal status by spectral-domain optical coherence tomography (SD-OCT) on visual outcomes in patients with rhegmatogenous retinal detachment (RRD) with foveal involvement. Methods. A retrospective dataset analysis of 508 eyes of 504 consecutive patients with primary RRD was performed. The primary outcome measure was the best-corrected visual acuity as a function of time between the assessment of the foveal status with SD-OCT upon initial examination at the department and RRD repair. Results. In total, 188 eyes (37.0%) had a complete foveal detachment and 31 (6.1%) eyes had a bisected fovea by the retinal detachment. A hundred eyes with total foveal detachment received surgery within 24 h and 65 eyes between 24 h and 72 h. Visual outcomes for eyes with detached fovea were significantly better when treated within 24 h (0.47 ± 0.39) compared with those treated between 24 h and 72 h (0.84 ± 0.66; p=0.01) after objectivation of the foveal status with SD-OCT. Pars plana vitrectomy was performed in 174 (92.6%) eyes and scleral buckling surgery in 14 (7.4%) eyes with complete foveal involvement of RRD. Conclusions. Our findings suggest improved visual outcomes for patients receiving surgery within 24 h after a definitive diagnosis of fovea-involving RRD compared to surgical interventions that were further delayed.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Timing on Visual Outcomes in Fovea-Involving Retinal Detachments Verified by SD-OCT

Angermann

Bechrakis

Rauchegger

et al. 2020

Journal of Ophthalmology

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“… 8 , 9 , 10 , 11 Prior studies have suggested a delay of 7 days can lead to worse visual outcomes, while some recent studies have suggested that a delay in even 3 days leads to worse visual acuity outcomes. 12 , 13 The purpose of this report is to investigate the effect of the initial COVID-19 pandemic on the clinical presentation of acute, primary RRD to a tertiary referral-based retina subspecialty practice setting.…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic

et al. 2021

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Objective To investigate the effect of the COVID-19 pandemic on the clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, consecutive case series with historical controls. Subjects Consecutive patients presenting with primary RRD in a 50-day period during the USA COVID-19 pandemic (March 9 th - April 27 th , 2020) and the corresponding 50-day period in the previous year (March 4 th - April 22 th , 2019). Methods The cohorts were compared to assess demographic variables and clinical presentations. Multivariate logistic regression was used to identify factors predictive of presenting macular attachment status. Main Outcome Measure The primary outcome was the proportion of patients with macula-on RRD at presentation. Secondary outcomes included visual acuity (VA), duration of symptoms prior to presentation, proportion presenting within one day of symptom onset, and presence of primary proliferative vitreoretinopathy (PVR). Results Eighty-two patients were included in the 2020 cohort compared to 111 patients in the 2019 primary control cohort. Demographic factors were similar between the groups. Significantly fewer patients presented with macula-on RRD in the 2020 cohort (20/82 patients, 24.4%) than in 2019 (55/111 patients, 49.5%, p = 0.001). Patients in the 2020 cohort had worse median VA at presentation (LogMAR 1.00, Snellen 20/200 in 2020 versus LogMAR 0.48, Snellen 20/60 in 2019, p = 0.008), fewer patients presenting within one day of symptoms (16/80 patients [19.5%] in 2020 versus 41/106 patients [36.9%] in 2019, p = 0.005), and a greater proportion with primary PVR (11/82 patients [13.4%] in 2020 versus 5/111 patients [4.5%] in 2019, p = 0.03). In multivariate analysis, younger age (p = 0.03) and established patient status (p = 0.02) were independent predictors of macula-on status in the 2020 cohort. Conclusions Patients with primary RRD during the 2020 COVID-19 pandemic were less likely to be macula-on and more likely to have delayed presentation, worse vision, and PVR.

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“…During RRD, the outer retina is separated from the RPE and choroid, resulting in marked metabolic derangements partially due to hypoxia. 18,19 In experimental models of RRD, the metabolic injury causes photoreceptor apoptosis that begins within 24 hours and peaks by day 3. 18,20 Greven et al reported that shorter duration of macular detachment is associated with better final visual acuity, even among patients whose detachment is ≤ 3 days.…”

Section: Discussionmentioning

confidence: 99%

Foveal Avascular Zone Area Analysis Using OCT Angiography After Pneumatic Retinopexy for Macula-Off Rhegmatogenous Retinal Detachment Repair

Francisconi

Kim

Juncal

et al. 2019

Journal of VitreoRetinal Diseases

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Purpose: Recent publications have reported that the deep capillary plexus (DCP) area of the foveal avascular zone (FAZ) is significantly larger in eyes following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair when compared with controls. To the best of the authors’ knowledge, there have been no publications on the evaluation of the macular microvasculature using optical coherence tomography angiography (OCTA) in post–pneumatic retinopexy (PnR) eyes. Therefore, the purpose of this study was to investigate FAZ-area changes following PnR. Methods: This retrospective cohort included 19 patients with macula-off RRD who underwent PnR repair. Each patient’s fellow eye was used as a control. The FAZ area in the superficial capillary plexus and DCP was investigated with OCTA and the areas were measured by 2 masked graders. Results: Both superficial (PnR: 0.22 [0.16-0.35] vs control: 0.24 [0.18-0.34] mm2; P = .715) and deep (PnR: 0.56 [0.51-0.76] vs control: 0.7 [0.59-0.89] mm2; P = .105) FAZ areas were not significantly different between eyes. Conclusions: Our results suggest that the lack of FAZ-area enlargement after PnR repair may indicate that there is less ischemic damage to the retinal capillary plexus in the fovea when compared with that described in the literature for PPV. The PIVOT trial demonstrated that PnR is associated with superior visual acuity and less metamorphopsia when compared with PPV at 1 year. The results of the current study may provide insight into the potential advantages of PnR. Further studies are needed to elucidate how the macular microvasculature is affected after RRD and to clarify how the FAZ area changes following PnR and PPV.

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Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment

Cited by 41 publications

References 17 publications

Effect of Timing on Visual Outcomes in Fovea-Involving Retinal Detachments Verified by SD-OCT

Effect of Timing on Visual Outcomes in Fovea-Involving Retinal Detachments Verified by SD-OCT

Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic

Foveal Avascular Zone Area Analysis Using OCT Angiography After Pneumatic Retinopexy for Macula-Off Rhegmatogenous Retinal Detachment Repair

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