Effect of Duration of Macular Detachment on Visual Prognosis after Surgery for Macula-Off Retinal Detachment: Japan-Retinal Detachment Registry

Abstract

To evaluate the association between the duration of macular detachment (DMD) and visual prognosis in patients with macula-off rhegmatogenous retinal detachment (RRD). Prospective observational cohort study PARTICIPANTS: This study analyzed 719 eyes with macula-off RRD registered with the Japan-Retinal Detachment Registry created by the Japan Retina and Vitreous Society. We included patients with macular detachment without a history of prior surgery, except cataract surgery and vitrectomy. Reoperation cases, hereditary RD, and macular hole RD were excluded. We compared the visual prognosis between patients with DMD of N days or less and those with DMD of N+1 days or more (N=2-5). For these four comparisons, the inverse probability of treatment weighting (IPTW) methodology was employed, to balance 20 baseline characteristics between the shorter and longer DMD groups. The baseline characteristics included age, sex, axial length, baseline visual acuity, operative procedures, and detailed characteristics of RD. P-values <0.01 were considered statistically significant. The best-corrected visual acuity (BCVA) six months after surgery RESULTS: The final analysis included 719 eyes. For all comparisons, the patients' backgrounds were well balanced after IPTW with standardized differences < 0.10. IPTW regression analysis revealed that the BCVA after six months was significantly better after surgeries for DMD of two days or less than that for DMD of three days or more. Similarly, the six-month BCVA for surgeries for DMD of three days or less was significantly better than that for surgeries for DMD of four days or more (differences in logarithm of the minimum angle of resolution: -0.113, P = 9.1×10-7; -0.076, P = 1.6×10-3, respectively). On the other hand, there were no statistically significant differences for the other comparisons. Earlier surgical treatment within three days from the onset of macular detachment should be considered, after accounting for social circumstances, such as weekends.