Repair Macula-off Retinal Detachment Within 72 Hours of Vision Loss For Best Outcomes

This study shows that prompt treatment of macula-off RD is associated not only with better final VA but also greater VA improvement.  Photo: Mark Dunbar, OD. Click image to enlarge. There is a growing consensus that urgent—i.e., within 72 hours of losing vision—repair of macula-off retinal detachment (RD) is associated with a better final visual acuity (VA). The relationship between duration of macular detachment and final VA  is complex. UK researchers recently used the joint Britain & Eire Association of Vitreoretinal Surgeons /Euretina Retinal Detachment Study Groups database to examine the factors that determine postoperative VA improvement in eyes with macula-off RD that were successfully treated by a single vitrectomy and internal tamponade. They found that greater postoperative visual acuity improvement was more likely in eyes that were pseudophakic at follow-up and had shorter durations of central vision loss. Non-modifiable factors associated with greater vision improvement included worse presenting vision, younger age, less extensive detachment and less than three breaks in the detached retina.The database included visual outcomes for 2,770 macula-off retinal detachments that were successfully reattached by vitrectomy and internal tamponade. Male patients accounted for 64.6% of the cohort, and the median age was 63 years old.The median preoperative VA was counting fingers (logMAR 1.98); this improved to 0.30 logMAR postoperatively. About 88.0% of eyes achieved VA improvement of ≥0.30 logMAR. The change in VA model identified the preoperative VA, patient age, duration of central vision loss, lens status at follow-up, extent of detachment and the number of breaks in the detached retina as factors influencing the change in VA. For 75.5% of eyes, the model prediction was within ±0.30 logMAR of the recorded VA change.The researchers noted that patient age, preoperative visual acuity, number of breaks in the detached retina and the extent of detachment will be determined prior to surgery. However, two can be modified by the surgeon: cataract and time to surgical reattachment.These results confirmed that prompt surgery improves functional outcomes in successfully treated macula-off retinal detachments irrespective of presenting visual acuity.Among unanswered questions, the researchers wrote that it is likely that a 24-hour delay has a significant impact on visual prognosis in the first 72 hours of vision loss. It is also probable that, in eyes that have been detached for more than two weeks, another 24-hour delay is unlikely to have the same effect.“While we can recommend prompt surgery for eyes with less than four days duration, we don’t know at what time point urgent surgery no longer improves the prognosis,” the study authors wrote in their paper. “If delaying surgery for 24 hours ever means that there is less risk of re-detachment, it may be justified to wait.”The study recommended that, provided that resources are available, macula-off RD should be repaired within 72 hours of losing vision.”Click here for the journal source. Yorston D, Donachie PHJ, Laidlaw DA, et al; members of the Britain & Eire Association of Vitreoretinal Surgeons (BEAVRS) and Euretina Retinal Detachment Study Groups. Predicting post-surgery change in visual acuity after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study. Eye (Lond). May 26, 2025. [Epub ahead of print].