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Shorter duration of macular detachment may improve visual acuity
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Patients may experience better visual acuity if the duration of macular detachment is shortened to 3 days or less, according to a study conducted by the Department of Ophthalmology at Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, Calif.
“A number of factors have been identified as predictive of poor visual outcomes, including presenting visual acuity, height of the detachment and duration of macular detachment [DMD],” Margaret A. Greven, MD, of Wake Forest Baptist Health in Winston-Salem, N.C., and colleagues wrote. “For the retinal surgeon, timing of the surgical repair is the only factor that has reliably been shown to affect visual outcomes.”
Researchers conducted a retrospective study of eyes that underwent repair within 1 week of vitrectomy or vitrectomy with scleral buckle for macula-off retinal detachment. The study used a linear model using DMD, postoperative lens status, preoperative visual acuity, patient age and surgeon. The patients were separated into two groups. Group 1 included 52 eyes with retinal detachment repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD.
Findings showed the average DMD of patients in group 1 was 2.0 +.09 days, and the average DMD of patients in group 2 was 4.0 +1.5 days. Macula-off detachments of 3 days or less in duration had better visual acuity outcomes than detachments spanning 4 to 7 days in duration. Researchers found that preoperative visual acuity and pseudophakia in the final follow-up with patients was associated with overall better final visual acuity.
“Based on these results, interventions that shorten the duration of the macula-off [retinal detachment], including those occurring within the first 3 days, may result in improved long-term [visual acuity] outcomes,” Greven and colleagues wrote. – by Erin T. Welsh
Disclosures:The authors report no relevant financial disclosures.
Perspective
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Carolyn E. Majcher, OD, FAAO
We have long been taught that a macula-off rhegmatogenous retinal detachment (RD) is less emergent than a macula-on RD, but how quickly should a recent macula-off RD be referred for repair? This novel study is the first to report that even within the first 3 days of detachment, earlier repair of macula-off RD results in improved long-term visual prognosis. The investigators found that among eyes with macula-off RD of 1 week’s duration or less, approximately one
line of final acuity was lost for each day of detachment, and eyes repaired within 24 hours fared best. These results suggest that recent onset macula-off RDs should be treated with the same sense of “emergency” as macula-on RDs and referred immediately. A delay in repair by just a few days may have a substantial detrimental impact on a patient’s daily functioning, driving and occupational performance. Presumably irreversible hypoxic photoreceptor damage begins rapidly following detachment, and perhaps surgical interventions that result in immediate apposition of the photoreceptors and RPE, such as vitrectomy, are superior to those that may have lingering subretinal fluid (scleral buckle alone).
Future OCT research should focus on identifying structural features of longer detachment duration that may predict poor visual prognosis, such as outer segment elongation (“shagginess”), retinal thinning and greater height of detachment. For now, this study suggests that clinicians should treat all retinal detachments with the same sense of urgency regardless of macular involvement: mainly, refer immediately!
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Greven M, et al. Br J Ophthalmol. 2018;doi:10.1136/bjophthalmol-2018-313191.
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