Impact of Duration of Macula off Rhegmatogenous Retinal Detachment on Visual Outcome

Impact of the Time to Surgery on Visual Outcomes for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis

PURPOSE

To determine the relationship between time from symptom onset or presentation to repair and visual outcomes for macula-on and macula-off rhegmatogenous retinal detachment (RRD).

DESIGN

Meta-analysis.

METHODS

We searched MEDLINE, EMBASE, and Cochrane Library for randomized controlled trials and observational studies comparing best-corrected visual acuity (BCVA) based on time to RRD repair. Study identifiers, baseline characteristics, intervention characteristics, and visual outcomes were extracted. We conducted a random effects meta-analysis. Sensitivity analyses included leave-1-out and influence analyses. Primary outcomes included mean difference (MD) in final BCVA, MD between preoperative and final BCVA (∆BCVA), and relative risk of final BCVA <0.4 logMAR for macula-off RRD repair in 0-3 vs 4-7 days and macula-on RRD repair in 0-24 vs >24 hours. Secondary outcomes assessed other time points.

RESULTS

Twenty observational studies reported on 1929 patients. Macula-off RRD repair in 0-3 days from symptom onset was superior to 4-7 days for final BCVA (MD -0.06 [95% CI -0.09, -0.03], P < .001) but was not different for ∆BCVA (P > .05). Macula-on repair in 0-24 hours from presentation was superior to >24 hours for final BCVA (MD -0.02 [95% CI -0.03, -0.01], P < .05) but was not different for ∆BCVA (P > .05).

CONCLUSIONS

Macula-off RRD repair in 0-3 days from symptom onset may have better final BCVA compared to repair in 4-7 days. Macula-on RRD repair in 0-24 hours of presentation may have better final BCVA compared to repair in >24 hours. These results were supported by moderate- and low-quality evidence, respectively, and may have been influenced by differences in baseline BCVA.

Effects of different tamponade materials on macular segmentation after retinal detachment repair

PURPOSE

This study used spectral domain-optical coherence tomography (SD-OCT) to evaluate individual retinal layer thickness in eyes with macula-off rhegmatogenous retinal detachment (RRD) treated with silicone oil (SiO) or gas endotamponades.

STUDY DESIGN

This was a retrospective, interventional, comparative study.

METHODS

The study included 86 eyes of 43 patients who were divided into 3 groups according to endotamponades: SiO, perfluoropropane (C3F8), and sulfur hexafluoride (SF6). The affected eyes were compared with the fellow eyes of the same patient via SD-OCT automated segmentation analysis. Patients with a follow-up of at least 6 months were included in the final analysis. Macular segmentation including the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retinal layers (IRLs), and outer retinal layers (ORLs) was analyzed.

RESULTS

In the SiO group, the mean thickness of each retinal layer including the RNFL, GCL, IPL, ONL, and IRLs within a 1-mm ETDRS subfield of the affected eyes was significantly lower than that of the fellow eyes (P = 0.036, P = 0.028, P = 0.003, P < 0.001, P = 0.013, respectively). There was no significant difference in the C3F8 and SF6 groups (all P > 0.05). The difference between the ONL and IRLs in the SiO-treated eyes differed significantly from that of the gas groups (P = 0.001 and P = 0.045, respectively) The difference in the GCL thickness of the affected eyes and healthy eyes showed a significant correlation with postoperative BCVA changes in the SiO, C3F8, and SF6 groups (P = 0.041, P = 0.048, and P = 0.045, respectively).

CONCLUSION

The findings of our study show that endotamponades used in RRD surgery may have different effects on retinal layers. In addition, SiO may cause undesirable effects on the retinal layers.

Characteristics of patients with complete visual acuity recovery after vitrectomy for macula-off retinal detachment

PURPOSE

The purpose of this study is to investigate potential factors predicting complete recovery of visual acuity following surgery for macula off retinal detachment (RD).

PATIENTS AND METHODS

Retrospective review of patients operated for macula-off RD at Jules-Gonin Eye Hospital between January 2015 and December 2016. The study included patients with visual acuity recovery of 0 LogMAR. A control group of 83 patients with comparable baseline characteristics but partial recovery of visual acuity after vitrectomy for macula-off RD was used for statistical comparison analysis.

RESULTS

Seventy-four patients, 46 males (62%) and 28 females (38%), were included. Mean age was 65 years (standard deviation: 12). Median follow-up was 6 months (interquartile range: 3). Fifty patients (68%) were pseudophakic. Median pre-op best-corrected visual acuity (BCVA) was 2 LogMAR (interquartile range: 1.22). Forty-three of the patients (58%) had preoperative BCVA equivalent of count fingers or less. The majority of the patients (91%) had up to 3-day duration of macular detachment (MD) before surgery. In comparison only 18% of the group of patients with partial recovery of visual acuity after vitrectomy for macula-off RD had been operated within 3 days of MD (p < 0.0001). In 63% of the 40 cases in whom an optical coherence tomography (OCT) of the fovea could be interpreted, OCT image showed a retained foveal depression of the detached retina, whereas only 35% of the 46 control eyes with adequate OCT imaging showed a retained foveal depression (p = 0.01).

CONCLUSIONS

In our study, patients had significantly better chances of complete visual acuity recovery when operated within 3 days of MD in comparison to more delayed surgery. Additionally, preservation of the foveal depression of the detached retina appeared to be a common characteristic among patients demonstrating complete visual recovery.

Scleral buckling-induced ocular parameter changes in different age group patients of rhegmatogenous retinal detachment

PURPOSE

This study was aimed to evaluate the difference in the ocular parameter changes following scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) in different age group patients.

MATERIALS AND METHODS

This prospective study included 26 eyes of 26 patients who underwent SB for uncomplicated RRD. The patients were divided into three age groups: 16-30 years (Group I), 31-45 years (Group II), and 46-60 years (Group III). Axial length (AL), anterior chamber depth (ACD), and corneal curvatures were measured preoperatively and postoperatively at 1 week, 1 month, and 3-month. The postoperative change and progression of these parameters were evaluated and compared between three age groups using nonparametric Wilcoxon signed-rank test and Kruskal-Wallis test.

RESULTS

At 3-month follow-up, a statistically significant postoperative AL increase, ACD decrease, and surgically induced astigmatism (SIA) were observed in all groups (Group I - 0.75 ± 0.32 mm, 0.21 ± 0.21 mm, and 1.5 ± 0.48 D, respectively; Group II - 0.79 ± 0.41 mm, 0.14 ± 0.04 mm, and 2.07 ± 1.18 D, respectively; Group III - 0.86 ± 0.33 mm, 0.16 ± 0.05 mm, and 1.56 ± 1.19 D, respectively). However, surgery-induced change for any parameter was not significantly different between the groups (P for AL [0.7955]; ACD [0.8805]; and SIA [0.5485]). Progression in postoperative changes in AL and ACD was insignificant during three follow-up examinations in all the groups. However, SIA of Group I continued to change significantly up to 3 months but stopped to change at 1 month only in Group II and III.

CONCLUSION

Age-related change in physical properties of ocular tissue does not have any major additional effect on the results of SB except that the postsurgical change in corneal curvature stops earlier in older patients compared to that in younger patients.