First Week Post-op BCVA Best Predicts Final Vision for Macula-off RRD

In this cohort of patients, a gradual improvement in BCVA was observed over the follow-up period after RD surgery. This improvement coincided with an increase in central foveal thickness. However, no significant correlation was found between central foveal thickness at one-week post-surgery and the final VA. Photo: Andrea Knouff, OD. Click image to enlarge. Many confounding variables and inconsistent selection criteria make researchers debate the key factors that influence visual prognosis in rhegmatogenous retinal detachment (RRD), particularly in cases that involve the macula.To eliminate these confounding factors, a recent study published in Retina included only patients with macular-off RRD treated by pars plana vitrectomy (PPV) with silicone oil tamponade without postoperative cystoid macular edema, subretinal fluid and epiretinal membrane. The researchers’ objective was to identify early postoperative factors that could predict visual acuity outcomes by evaluating preoperative and postoperative factors such as clinical, surgical and OCT findings. They determined that patients with a best-corrected visual acuity (BCVA) of 0.7 logMAR (20/100) or less at one week, without preoperative intraretinal cysts and who are operated on within 15 days of initial symptoms have the best-predicted final vision.The study was a retrospective review of 59 eyes from 59 patients who underwent pars plana vitrectomy and silicone oil tamponade for macula-off RRD. Among them, 41 (69.5%) were male and 18 (30.5%) were female. The mean age at the onset of RRD was 50.07 years. The presumptive duration of RD was seven days. Only two eyes (3.39%) had less than one quadrant of detachment. Furthermore, 46 patients (78%) had more than one intraretinal cyst before surgery, as observed on preoperative OCT images. The duration of silicone oil tamponade was three months, and the total follow-up time was seven months. BCVA improved in all 59 patients. The best visual outcome achieved was a logMAR of 0 (20/20) and was observed in 14 patients (23.7%).The baseline preoperative best-corrected visual acuity improved from 1.67 logMAR to 0.21 logMAR at the final visit. Central foveal thickness and best-corrected visual acuity showed significant increases from one-week post-surgery onward. The mean central foveal thickness significantly increased from 136.97µm to 192.54µm. The percentage of eyes with integrated external limiting membrane and ellipsoid zone progressively increased from 45.76% and 10.17% to 98.31% and 71.19%, respectively. BCVA at one week after surgery, external limiting membrane integrity, preoperative intraretinal cysts and macula-off duration were significantly associated with final visual recovery after surgery.Patients whose BCVA at one week who were not more than 0.7 logMAR, without preoperative intraretinal cysts and operated on within 15 days of initial symptoms had the best predicted final vision of 0.006 logMAR.The researchers concluded in their paper that “further studies are warranted to determine whether OCT can provide useful prognostic information for patients with macula-off RRD.”Click here for the journal source. Zhao Y, Sheng Y. Preoperative and early postoperative factors associated with visual outcome after macular-off retinal detachment surgery. Retina. 2025;45(6):1056-62.