Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes

  • Irene T. Lee
  • Shaun I.R. Lampen
  • Tien P. Wong
  • James C. MajorJr
  • Charles C. WykoffEmail author
Retinal Disorders



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.


Retina Retinal detachment Vitreoretinal surgery 


Compliance with ethical standards

Conflicts of interest

All authors have completed the ICMJE uniform disclosure form at 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, 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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Burton TC, Lambert RW (1978) A predictive model for visual recovery following retinal detachment surgery. Ophthalmology 85:619–625CrossRefGoogle Scholar
  2. 2.
    Tani P, Robertson DM, Langworthy A (1980) Rhegmatogenous retinal detachment without macular involvement treated with scleral buckling. Am J Ophthalmol 90:503–508CrossRefGoogle Scholar
  3. 3.
    Wilkinson CP (1981) Visual results following scleral buckling for retinal detachments sparing the macula. Retina 1:113–116CrossRefGoogle Scholar
  4. 4.
    Salicone A, Smiddy WE, Venkatraman A, Feuer W (2006) Visual recovery after scleral buckling procedure for retinal detachment. Ophthalmology 113:1734–1742CrossRefGoogle Scholar
  5. 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. 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
  7. 7.
    Iandiev I, Uckermann O, Pannicke T, Wurm A, Tenckhoff S, Pietsch U-C et al (2006) Glial cell reactivity in a porcine model of retinal detachment. Invest Ophthalmol Vis Sci 47:2161–2171CrossRefGoogle Scholar
  8. 8.
    Hollborn M, Francke M, Iandiev I, Bühner E, Foja C, Kohen L et al (2008) Early activation of inflammation- and immune response-related genes after experimental detachment of the porcine retina. Invest Ophthalmol Vis Sci 49:1262–1273CrossRefGoogle Scholar
  9. 9.
    Wykoff CC, Smiddy WE, Mathen T, Schwartz SG, Flynn HW, Shi W (2010) Fovea-sparing retinal detachments: time to surgery and visual outcomes. Am J Ophthalmol 150:205–210CrossRefGoogle Scholar
  10. 10.
    Ho SF, Fitt A, Frimpong-Ansah K, Benson MT (2006) The management of primary rhegmatogenous retinal detachment not involving the fovea. Eye 20:1049–1053CrossRefGoogle Scholar
  11. 11.
    Ehrlich R, Niederer RL, Ahmad N, Polkinghorne P (2013) Timing of acute macula-on rhegmatogenous retinal detachment repair. Retina 33:105–110CrossRefGoogle Scholar
  12. 12.
    Lai MM, Khan N, Weichel ED, Berinstein DM (2011) Anatomic and visual outcomes in early versus late macula-on primary retinal detachment repair. Retina 31:93–98CrossRefGoogle Scholar
  13. 13.
    Wilkinson CP, Rice TA (1997) Michels Retinal Detachment St. Louis, MissouriGoogle Scholar
  14. 14.
    Kontos A, Williamson TH (2017) Rate and risk factors for the conversion of fovea-on to fovea-off rhegmatogenous retinal detachment while awaiting surgery. Br J Ophthalmol 101:1011–1015CrossRefGoogle Scholar
  15. 15.
    No a l (1990) The repair of rhegmatogenous retinal detachments. Ophthalmology 97:1562–1572CrossRefGoogle Scholar
  16. 16.
    Hartz AJ, Burton TC, Gottlieb MS, McCarty DJ, Williams DF, Prescott A et al (1992) Outcome and cost analysis of scheduled versus emergency scleral buckling surgery. Ophthalmology 99:1358–1363CrossRefGoogle Scholar
  17. 17.
    Frimpong-Ansah K, Kirkby GR (2000) Arrangements for the management of urgent retinal detachments in the United Kingdom and Eire in the year 2000: results of a survey. Eye 16:754–760CrossRefGoogle Scholar
  18. 18.
    Rojas J, Fernández I, Pastor JC, Gómez-Ulla F, Piñero A (2007) Urgent retinal detachment management by the National Health System of Spain. Project retina 2. Arch Soc Esp Oftalmol 82:279–284CrossRefGoogle Scholar
  19. 19.
    Goldstein SD, Papandria DJ, Aboagye J, Salazar JH, Van Arendonk K, Al-Omar K et al (2014) The “weekend effect” in pediatric surgery - increased mortality for children undergoing urgent surgery during the weekend. J Pediatr Surg 49:1087–1091CrossRefGoogle Scholar
  20. 20.
    Zapf MAC, Kothari AN, Markossian T, Gupta GN, Blackwell RH, Wai PY et al (2015) The “weekend effect” in urgent general operative procedures. Surgery 158:508–514CrossRefGoogle Scholar
  21. 21.
    Desai V, Gonda D, Ryan SL, Briceño V, Lam SK, Luerssen TG et al (2015) The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients. J Neurosurg Pediatr 16:726–731CrossRefGoogle Scholar
  22. 22.
    Tadisina KK, Chopra K, Singh DP (2015) The “weekend effect” in plastic surgery: analyzing weekday versus weekend admissions in body contouring procedures from 2000 to 2010. Aesthet Surg J 35:995–998CrossRefGoogle Scholar
  23. 23.
    Algvere P, Rosengren B, Immobilization of the eye (1977) Evaluation of a new method in retinal detachment surgery. Acta Ophthalmol 55:303–316CrossRefGoogle Scholar
  24. 24.
    Lean JS, Mahmood M, Manna R, Chignell AH (1980) Effect of preoperative posture and binocular occlusion on retinal detachment. Br J Ophthalmol 64:94–97CrossRefGoogle Scholar
  25. 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
  26. 26.
    Lincoff H, Stopa M, Kreissig I (2004) Ambulatory binocular occlusion. Retina 24:246–253CrossRefGoogle Scholar
  27. 27.
    Foster WJ (2011) Bilateral patching in retinal detachment: fluid mechanics and retinal “settling”. Invest Ophthalmol Vis Sci 52:5437–5440CrossRefGoogle Scholar
  28. 28.
    de Jong JH, Vigueras-Guillén JP, Simon TC, Timman R, Peto T, Vermeer KA et al (2017) Preoperative posturing of patients with macula-on retinal detachment reduces progression toward the fovea. Ophthalmology 124:1510–1522CrossRefGoogle Scholar
  29. 29.
    Writing Committee for the UK Age-Related Macular Degeneration EMR Users Group (2014) The neovascular age-related macular degeneration database: multicenter study of 92,976 ranibizumab injections: report 1: visual acuity. Ophthalmology 121:1092–1101CrossRefGoogle Scholar
  30. 30.
    Bressler SB, Qin H, Beck RW, Chalam K, Kim JE, Melia M et al (2012) Factors associated with changes in visual acuity and OCT thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol 130:1153–1161CrossRefGoogle Scholar
  31. 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
  32. 32.
    Sodhi A, Leung L-S, Do DV, Gower EW, Schein OD, Handa JT (2008) Recent trends in the management of rhegmatogenous retinal detachment. Surv Ophthalmol 53:50–67CrossRefGoogle Scholar
  33. 33.
    Weichel ED, Martidis A, Fineman MS, McNamara JA, Park CH, Vander JF et al (2006) Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology 113:2033–2040CrossRefGoogle Scholar
  34. 34.
    Kinori M, Moisseiev E, Shoshany N, Fabian ID, Skaat A, Barak A et al (2011) Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol 152:291–297CrossRefGoogle Scholar
  35. 35.
    Lindsell LB, Sisk RA, Miller DM, Foster RE, Petersen MR, Riemann CD et al (2016) Comparison of outcomes: scleral buckling and pars plana vitrectomy versus vitrectomy alone for primary repair of rhegmatogenous retinal detachment. Clin Ophthalmol 11:47–54CrossRefGoogle Scholar
  36. 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
  37. 37.
    Azad RV, Chanana B, Sharma YR, Vohra R (2007) Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand 85:540–545CrossRefGoogle Scholar
  38. 38.
    Kreissig I (1977) Prognosis of return of macular function after retinal reattachment. Mod Probl Ophthalmol 18:415–429Google Scholar
  39. 39.
    Davidorf FH, Havener WH, Lang JR (1975) Macular vision following retinal detachment surgery. Ophthalmic Surg 6:74–81Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Retina Consultants of HoustonHoustonUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Blanton Eye InstituteHouston Methodist Hospital & Weill Cornell Medical CollegeHoustonUSA

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