The management of primary rhegmatogenous retinal detachment not involving the fovea

Abstract

Aim To establish the likelihood of, and risk factors associated with, progression of 'macula-on' retinal detachment. Methods A multi-centre prospective observational study of patients with acute retinal detachment, not involving the fovea, was conducted over a 6-month period. Data collected included duration of symptoms, visual acuity, presence of posterior vitreous detachment, retinal drawings and subretinal fluid (SRF) distance from the fovea at a minimum of two time points. Results A total of 82 data sets from 15 institutions were analysed. Of 82 cases 11 (13%) demonstrated progression of fluid. Mean progression in those cases which progressed was 2.3 disc diameters (dd) and the average rate of progression was 1.80 dd/day. Binary regression analysis failed to reveal any statistically significant risk factors for progression. Multiple regression analyses were made to identify risk factors. With distance of SRF from fovea at operation as a function, distance of SRF at presentation was the only statistically significant risk factor. In all, 26% of patients underwent surgery out-ofhours. A total of 83% patients achieved a 6-week best-corrected vision of 6/9 or better. Conclusion Most retinal detachments in this study did not progress within the first few days. The distance of SRF from the fovea at presentation was the only statistically significant risk factor for progression to foveal detachment.

Treatment of macula-on retinal detachments

“…1,2 In a letter, Prasad 1 asserts that 'best evidence indicates that there is no benefit in urgent surgery as long as scheduled surgery can be performed within 7-10 days'. We are concerned that he has misread his supporting references, which are concerned with visual recovery in macula-off retinal detachments, including one entitled 'visual recovery in macula-off retinal detachments'.…”

“…2 The authors qualify their results with a number of study weaknesses that render meaningful conclusions virtually impossible, apart from the finding that if the macula is just about to come off it may well do so in the very near future. That the majority of patients with macula-on retinal detachments do not become macula-off before surgery does not mean that it is acceptable for some patients to lose vision because of undue delay.…”

“…1,2 If they read beyond the title of the article I supposedly misquoted, 2 it would become clear that this report specifically addresses macula-off detachments where the macula was determined to have come off within the last 7 days. This is exactly what we are trying to address here.…”

Effect of Symptom Duration until Surgery on First-Year Outcome in Pseudophakic Primary Rhegmatogenous Retinal Detachment

“…Different studies evaluated functional outcomes of RRD repair depending on the time point of surgery [6][7][8][9][10][11] . For example, Hassan et al [6] could find no effect on the final visual outcome for the first 10 days of duration of the detachment, but a decrease in visual acuity after 10 days and again after 6 weeks of symptom duration.…”

“…In the first 10 days after onset of symptoms, the timing of reattachment surgery does not seem to have an impact on visual outcome in macula-off situations. In cases of symptom duration >10 days, functional outcome may be affected adversely [6][7][8][9][10][11] . A recent study concluded that eyes treated up to 3 days after onset of loss of central vision have better final visual acuity than eyes with longer lag time [12] .…”