Operate Within 3 Days of Macular-Involving Retinal Detachment For Best Results

Surgical intervention within 3 days of  macular-involving retinal detachment onset, can result in better visual outcome 6 months post-surgery than intervention at 4 days, according to a study published in Ophthalmology Retina. This study was designed to overcome the shortcomings of previous studies, which included missing data, and the inability to cope with different biases, such as indication bias and institutional differences, the researchers explain. 

This observational study analyzed the Japan-Retinal Detachment Registry, which is a prospectively registered repository of retinal detachment surgeries, and included 719 eyes (mean age, 56.5±16.0 years; 503 men) with macular-involving retinal detachment. The registry provided researchers basic patient information, cause and nature of retinal detachment, the surgical procedure, and surgical outcome of each case. It also included visual acuity obtained 1, 3, and 6 months postoperative, and retinal restoration information.

The time interval between macular detachment and surgery is influenced by various conditions such as institutional policy, the extent of retinal detachment, causes of retinal detachment, the patient’s age, according to the study authors. The background between cases and control was balanced by using the inverse probability of treatment weighting (IPTW) method, they explain. A total of 20 baseline characteristics were employed to balance the background via this method.

Each case was allocated into one of the following 5 groups according to the time interval between macular detachment and surgery: within 2 days, 3 days, 4 days, 5 days, 6 days or more. The researchers determined optimal timing for intervention by comparing the visual outcome between each group and its immediate following group (for example, the 2 days group was compared with the 3 days group, and the 3 days group was compared with the 4 days group).

The participant’s sex, the extent of retinal detachment, size of tears, proliferative vitreoretinopathy stage, number of tears, and tear type differed significantly between the groups (P =.005, P <.001, P <.001, P =.019, P =.043, respectively). The proportion of pars plana vitrectomy, scleral buckling, or a combination differed significantly as well.

The researchers found a significantly better visual acuity (VA) 6 months after surgery for patients operated on within 2 days from macular detachment than after 3 days (difference,  -0.113; standard error (SE), 0.023; P =9.1×10-7). A significant difference was also found between the visual outcome of patients in groups 3 days and 4 days (difference, -0.076; SE, 0.024; P =1.6×10-3). No significance was observed between the 6 months postoperative VA of groups 4 days and 5 days or between groups 5 days and 6 days or more.

“These results are consistent with the findings of basic research using experimental retinal detachment models, which showed that cone cells initiate apoptosis within one day of retinal detachment and peak at approximately three days,” according to the study authors. “On the other hand, for cases where the duration of macular detachment exceeded four days, earlier surgery had no substantial beneficial effect on visual prognosis.”.

The limitations of the study include its observational nature, possible imprecision of the duration of macular detachment, which was determined based on the patient’s complaint, and that social circumstances were not considered.