Macula off retinal detachments. How long can they wait before it is too late?

Eur J Ophthalmol. Jan-Feb 2005;15(1):109-17.

Abstract

Purpose: To determine the association between the duration of macula off detachment and the visual outcome following corrective surgery.

Methods: Retrospective review of the medical records of patients who underwent surgery for macula off detachment over a 5 year period (April 1994- March 1999).

Results: There were 104 patients in the study. Patients with macula off detachments wait a mean of 2.6 weeks (+/-0.3 SE mean) before presentation and 1.8 weeks (+/-0.2 SE of mean) thereafter before surgery. The mean duration of detachment prior to surgical repair was 4.2 weeks (+/-0.3 SE mean). 78% of patients achieved a postoperative improvement in visual acuity. 36.5% achieved functional visual success of 6/12 at 3 months, which increased to 51% at final discharge. There was no significant difference in visual outcomes for patient undergoing internal vs external procedures (p=0.188). The preoperative visual acuity was the most significant predictor of post operative visual acuity (p<0.0005). Less than 40% of macula off detachments of > or =6 weeks duration will achieve a vision of 6/12 or better compared with 68.2% of patients with macula off detachments of < or =1 week.

Conclusions: The best mean postoperative vision (LogMAR 0.35) was seen in patients with detachment of <1 week duration. Patients <60 years are more likely to achieve visual improvement despite the duration of the detachment. Macula off detachments of >6 weeks duration have a significantly poor postoperative visual prognosis. Awareness of this visual prognosis can assist in planning the timing of surgery to ensure an acceptable result.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Cryotherapy
  • Female
  • Humans
  • Macula Lutea / physiopathology
  • Macula Lutea / surgery*
  • Male
  • Middle Aged
  • Retinal Detachment / physiopathology
  • Retinal Detachment / surgery*
  • Retrospective Studies
  • Scleral Buckling
  • Time Factors
  • Treatment Outcome
  • Visual Acuity / physiology*
  • Vitrectomy