Visual Recovery after Scleral Buckling Surgery in Macula-Off Rhegmatogenous Retinal Detachment

Abstract

Purpose: The primary goal of this study was to investigate the functional results after scleral buckling (SB) surgery in macula-off rhegmatogenous retinal detachment (RRD), with more or less than 7 days’ duration of macular detachment (DMD). The secondary outcome measure was to determine the long-term functional results in these two groups 5 years after SB surgery. Methods: The retrospective studies included 96 eyes of 96 patients with primary, uncomplicated, macula-off RRD. Two studies, one with a short-term follow-up and one with a long-term follow-up, were performed, and in both studies the eyes were divided into two groups according to the DMD. In study I, 96 patients were divided into DMD ≤7 days (n = 73) and prolonged DMD more than 7 days (n = 23) with a postoperative follow-up of at least 3 months (mean 43.5 months). In a subgroup analysis, patients were divided into acute DMD ≤3 days (n = 37) and subacute DMD ≧4 days and ≤7 days (n = 36). Study II included 47 patients with a follow-up of at least 5 years (mean 6 years). All patients were divided into(subacute) DMD ≤7 days (n = 36) and (prolonged) DMD of >7 days (n = 11). Additional preoperative predictive factors including DMD, preoperative visual acuity (VA) and patients’ age at the time of the RRD were correlated with the postoperative VA. Results: In study I, the mean final VA was significantly better (0.45) after a DMD of less than or equal to 7 days, compared to patients with a DMD of more than 7 days (0.22; Student’s t test, p = 0.02). VA ≧0.4 was achieved in 68% with a subacute DMD compared to 52% in patients with prolonged DMD (χ² test, p < 0.001). However, the postoperative VA (0.48 ± 0.09) in eyes with DMD of 1–3 days was similar (0.42 ± 0.07) to eyes with DMD of 4–7 days (Student’s t test, p = 0.455). We divided the 96 patients into 2 groups according to a preoperative VA. Eyes with a preoperative VA ≤0.1 (n = 62) had a significantly lower final VA compared to eyes with a preoperative VA >0.1 (n = 34; Student’s t test, p < 0.001). Patients 75 years of age or younger were more likely to achieve a VA of 0.4 or better after SB surgery than older patients (more than 75 years; χ² test, p = 0.008). In study II, VA improved (by a mean of 1.60 ± 0.02 lines) during the follow-up period from 0.32 ± 0.08 at the 3-month follow-up to 0.46 ± 0.10 at the 5-year follow-up. Eyes with a subacute DMD had a significantly better VA than eyes with a prolonged DMD (Student’s t test, p = 0.004). Patients aged 75 years or less were more likely to achieve a VA of 0.4 or better than patients older than 75 (χ² test, p = 0.003). Conclusion: The time point of SB surgery has no statistical impact on the final visual recovery in patients with an acute primary macular-off RRD of less than or equal to 7 days. A delay of SB surgery within this time frame does not contribute to an impaired final visual outcome. There was no evidence, that primary macula-off RRDs are emergencies, which cannot wait for a systemic evaluation of the RRD and surgical t...

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): predictive factors for functional outcome. Study report no. 6

“…Preoperative BCVA might be a better surrogate of macular status, and this was found to be associated with functional outcome. However, other studies reported the "macula detached" classification to be a relevant prognostic factor for functional outcome [6,[23][24][25][26][27][28].…”

Modelling postoperative visual acuity with and without proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment

“…[26][27][28] Better preoperative VA, a shorter duration of detachment, fewer involved quadrants, younger age, and a lack of macular involvement with the detachment are important positive prognostic factors for VA. [29][30][31] In both groups of patients in our study (those with and those without PVR), the preoperative logMAR VA differed (Table 1) depending on whether the macula was involved. However, in both groups of patients no difference in the 8-month-postoperative logMAR was seen in patients with or without macular involvement.…”

State of the art und Zukunft der Vitrektomie – Techniken und Instrumente

“…Eine verzögerte Therapie ist mit einer limitierten Sehverbesserung assoziiert [36]. Seit 1929 ist die chirurgische Intervention mit Behandlung des verursachenden Netzhautdefektes beschrieben [37].…”