Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes
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Evaluate the impact of time to surgery and other clinical factors on visual and anatomic outcomes following surgical repair of fovea-sparing rhegmatogenous retinal detachments (RRD).
Visual and anatomic outcomes were analyzed for their association with clinical factors, including lens status, preoperative visual acuity (VA), contralateral RRD, RRD symptom duration, time to surgery, single-operation anatomic success, number of quadrants involved, posterior RRD extent, RRD extent closest to the fovea, number of retinal breaks, quadrants with retinal breaks, and surgery performed Saturday or Sunday versus Monday–Friday.
Medical records of 423 eyes with fovea-sparing RRD repaired with pneumatic retinopexy (PR), scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) were included. Sixty-seven percent and 89% were operated within 24 and 72 h of RRD presentation, respectively. Single-operation anatomic success rates were 59%, 89%, 84%, and 92% for PR, SB, PPV, and PPV/SB interventions, respectively. Final anatomic success was 100%. Three clinical factors correlated with faster time to surgery: shorter symptom duration (p < 0.02), RRD superior location (p = 0.001), and posterior extension into the macula (p = 0.01). The time to surgery did not correlate with visual or anatomic outcomes. Two clinical factors positively correlated with postoperative vision: preoperative VA (r > 0.25, p < 0.04) and single-operation anatomic success (p < 0.04). Surgeries performed on Monday through Friday (n = 411) were associated with better anatomic outcomes compared with the limited number performed on Saturday or Sunday (n = 12) (p = 0.005), although a greater proportion of operated cases over the weekend were PR.
In the context of the current series, time to surgery did not correlate with visual or anatomic outcomes following the surgical repair of fovea-sparing RRDs. Preoperative VA and single-operation anatomic success correlated with improved visual outcome.
KeywordsRetina Retinal detachment Vitreoretinal surgery
Compliance with ethical standards
Conflicts of interest
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: CCW has received research grants from Adverum Biotechnologies, grants from Aerpio Therapeutics, grants and personal fees from Alcon Laboratories, Inc., grants from Aldeyra Therapeutics, Inc., grants from Alimera Sciences, Inc., grants from Allegro Ophthalmics, LLC, grants and personal fees from Allergan, Inc., personal fees from Alnylam Pharmaceuticals, grants from Apellis Pharmaceutical, personal fees from Atheneum Partners, grants from Astellas Pharma Inc., grants from Aura Biosciences, Inc., personal fees from Bayer AG, grants from Boehrigner-Ingelheim, grants from Chiltern International, Inc., personal fees from Consultants LLC, personal fees from CORCEPT, personal fees from Destum Partners Inc., personal fees from D.O.R.C., grants and personal fees from Genentech, Inc., grants from GlaxoSmithKline, grants from Heidelberg Engineering, personal fees from Hexal AG, grants from Iconic Therapeutics, grants from INC Research, grants from John Hopkins University, personal fees from k2c Medical Communications, grants from NEI, personal fees from Notal Vision, grants from Novartis International AG, personal fees from Novo Nordisk, grants from OHR Pharmaceutical, Inc., personal fees from ONL Therapeutics, Inc., grants from Ophthotech Corporation, grants from Ora, Inc., grants from pSivida Corp., grants and personal fees from Regeneron Pharmaceuticals, grants from Regenexbio Inc., grants and personal fees from Roche, grants and personal fees from Santen Inc., personal fees from Prime Education LLC, grants from SciFluor Life Sciences, LLC, personal fees from System Analytic, grants from Taiwan Liposome Company, personal fees from ThromboGenics NV., grants from Tyrogenex, Inc., personal fees from Valeant Pharmaceuticals International, Inc., grants and personal fees from Clearside Biomedical, outside the submitted work; JCM has received research grants and personal fees from Alimera, grants from Acucela, grants from Alcon, grants from Allergan, grants from Apellis, grants from Clearside Biomedical, grants from D.O.R.C., grants from DRCR.net, grants and personal fees from Genentech, grants from Iconic, grants from Novartis, grants from Ophthotech, grants from Roche, grants from Regeneron, grants from Bayer, grants from Santeen, grants from Thrombogenics, grants from Tyrogenex, outside the submitted work; TPW, ITL, and SIRL declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
- 5.Geller SF, Lewis GP, Fisher SK (2001) FGFR1, signaling, and AP-1 expression after retinal detachment: reactive Müller and RPE cells. Invest Ophthalmol Vis Sci 42:1363–1369Google Scholar
- 6.Nakazawa T, Matsubara A, Noda K, Hisatomi T, She H, Skondra D et al (2006) Characterization of cytokine responses to retinal detachment in rats. Mol Vis 12:867–878Google Scholar
- 13.Wilkinson CP, Rice TA (1997) Michels Retinal Detachment St. Louis, MissouriGoogle Scholar
- 25.Johnston PB, Collins A, Maguire CJ, Logan WC (1982) Ocular immobilization and its role in the management of superior retinal detachment. Trans Ophthalmol Soc U K 102:233–236Google Scholar
- 31.Cohen E, Zerach A, Mimouni M, Barak A (2015) Reassessment of pneumatic retinopexy for primary treatment of rhegmatogenous retinal detachment. Clin Ophthalmol 9:2033–2037Google Scholar
- 36.Cankurtaran V, Citirik M, Simsek M, Tekin K, Teke MY (2017) Anatomical and functional outcomes of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Bosn J Basic Med Sci 17:74–80Google Scholar
- 38.Kreissig I (1977) Prognosis of return of macular function after retinal reattachment. Mod Probl Ophthalmol 18:415–429Google Scholar
- 39.Davidorf FH, Havener WH, Lang JR (1975) Macular vision following retinal detachment surgery. Ophthalmic Surg 6:74–81Google Scholar