Eight days is magic number for macular reattachment

Individuals who have a macula-off rhegmatogenous retinal detachment (RRD) for up to 8 days before being treated can expect continued improvement in their visual acuity (VA) for up to a year after reattachment surgery, show study results.

Conversely, those who have the condition for more than 8 days before being treated will only see an improvement in VA up to 6 weeks postsurgery.

"Data from this study suggests that after 8 days of macular detachment, the final visual outcome may be adversely affected, and thus, operative repair within this period is desirable," write Danny Mitry (University of Edinburgh, UK) and colleagues in the British Journal of Ophthalmology.

The findings emerge from data for 291 Scottish patients with macula-off RRD who were treated at four surgical centers between 2007 and 2009, and then evaluated 6 weeks, 3 months, 6 months, and 1 year postsurgery.

The mean duration of detachment, defined as the time between onset of symptoms (sudden vision loss), and surgery, was 5 days, note Mitry et al, who add that the mean preoperative VA - measured using Snellen notation and converted to logMAR units - was 1.71.

The majority of patients underwent a pars plana vitrectomy (76.6%), with more than half of the whole cohort (53.6%) showing an improvement in VA of at least 0.1 logMAR units between the first and final follow up, reports the team.

Indeed, the mean VA improved from 0.87 logMAR at the 6-week follow up to 0.57 logMAR at 1 year (where a score of 0.00 units denotes perfect 20/20 vision), and only 10% of patients had a worse VA at final follow up compared with the first follow up.

The authors observed an almost linear trend relationship between the final mean VA and mean duration of macula detachment, with two time points in particular, day 8 and day 21, associated with significantly worse VA at final follow up.

Adjusted analysis revealed that patients treated within 8 days of developing the condition had significant improvements in VA up to 12 months post-treatment, with logMAR scores of 0.81, 0.60, 0.55, and 0.45 at the 6-week, 3-month, 6-month, and 1-year follow ups, respectively, compared with 1.73 pretreatment.

Corresponding scores for those with a detachment duration of more than 8 days did not reveal any significant improvement over these time points, at logMAR 0.98, 0.82, 0.86, and 0.79, compared with 1.67 pretreatment.

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