Abstract
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.
Highlights
In the management of foveal detachment, the time until surgery is the most important prognostic factor for final visual acuity (FVA) after reattachment [1, 2]
A total of 219 (43.1%) eyes presented with foveainvolving detachment, 188 eyes (37.0%) had a complete foveal detachment, and 31 (6.1%) eyes had a fovea bisected by a retinal detachment
At baseline of fovea-off rhegmatogenous retinal detachment (RRD), there was no significant difference between the time groups
Summary
In the management of foveal detachment, the time until surgery is the most important prognostic factor for final visual acuity (FVA) after reattachment [1, 2]. Several factors, such as height of foveal detachment, age, and preoperative visual acuity, have been determined to have an impact on visual outcomes. 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). Accurate dating of foveal detachment is a limitation faced by all prior studies addressing surgical timing of macula-off RRD. A study by Ricker et al [6] found that onethird of patients with assumed foveal attachment, as determined by clinical symptoms and fundoscopy, showed foveal detachment by optical coherence tomography (OCT)
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