What Is the Optimal Timing for Rhegmatogenous Retinal Detachment Repair?

Abstract

Rhegmatogenous retinal detachment (RRD) is a common ocular disorder that occurs in approximately 1 of 170 eyes over a lifetime, often indicating urgent surgical intervention. Rhegmatogenous retinal detachments can be divided into fovea-sparing and fovea-involving detachments. In some cases, this distinction can be challenging and in these instances, central visual function, symptoms, and ocular coherence tomography (OCT) are helpful indicators of foveal status. Preoperative visual acuity (VA) is the strongest prognostic indicator of postoperative visual outcome. When central visual function is preserved and subretinal fluid has not extended through the fovea, prognosis for visual recovery is often quite good, with approximately 80% of eyes ultimately achieving a VA of 20/40 or better. In comparison, when central vision is affected, indicating involvement of the foveal photoreceptors, prognosis is less optimistic and more variable with approximately 30% of patients ultimately achieving a VA of 20/40 or better. 1 When patients present with a fovea-involving RRD, they often expect successful anatomic and visual outcomes. From an anatomic perspective, technologic advances have yielded a host of excellent repair techniques including scleral buckling, pars plana vitrectomy, cryotherapy, pneumatic retinopexy, and, rarely, clinical observation. Choice of surgical technique may be influenced by social issues, such as need for air travel in the near future, patient compliance and reliability, and medical conditions, such as sickle-cell disease. In comparison, from a visual recovery perspective, therapies for neural regeneration in