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Purpose: To evaluate the association of baseline morphologic stage of rhegmatogenous retinal detachment (RRD) using OCT with postoperative anatomic and visual acuity (VA) outcomes., Design: Retrospective cohort study., Subjects: Consecutive primary fovea-involving RRDs referred from January 2012 to September 2022., Methods: Patients with primary RRD and no prior macular pathology with gradable baseline OCT were assessed. Best-corrected VA (BCVA) was assessed at presentation and at 3, 6, and 12 months postoperatively. OCT scans were graded for parafoveal morphologic stage of RRD and foveal photoreceptor integrity., Main Outcome Measures: Association of morphologic stage of RRD with 12-month BCVA., Results: Three hundred fifty-one patients were included. Sixty-eight percent (238/351) were male, the mean (standard deviation) age was 61.2 (± 12.8) years, and 59% (206/351) were phakic. Thirteen percent (47/351) presented in stages 1 and 2, 15% (54/351) in stage 3a, 36% (126/351) in stage 3b, 24% (83/351) in stage 4, and 12% (41/351) in stage 5. Increasing stage was associated with worse foveal photoreceptor integrity, reduced baseline BCVA and longer duration of central vision loss (P < 0.001). Mean (standard deviation) 12-month BCVA by stage was 0.77 (± 0.64) for stages 1 and 2, 1.00 (± 0.53) for stage 3a, 1.36 (± 0.55) for stage 3b, 1.33 (± 0.66) for stage 4 and 1.55 (± 0.47) for stage 5. Increasing stage was associated with reduced postoperative BCVA (P < 0.001) at all time points after adjusting for covariates. A subgroup analysis of acute detachments with retinal pigment epithelium-photoreceptor dysregulation demonstrated no difference in postoperative BCVA between stages 1, 2, and 3a. However, 12-month BCVA was significantly better in stages 1, 2, and 3a vs. stage 3b (P = 0.002) and stage 3a vs. 3b (P = 0.008)., Conclusions: This study validates the clinical relevance of a recently proposed OCT-based staging system for outer retinal morphologic changes over time in RRD. Postoperative BCVA was significantly reduced in patients with worse presenting stage at all time points. In acute RRDs, 12-month BCVA was significantly better in stages 1, 2, and 3a vs. stage 3b, which suggests early stages may have better retinal recovery compared with stage 3b or worse. Stage 3b may represent a critical point where substantial structural changes occur, leading to worse outcomes in acute RRDs. Patients presenting with fovea-involving RRDs in stages 1, 2, or 3a may benefit from more urgent intervention., Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

AIM: To observe the efficacy of the minimal scleral buckling in the treatment of long-standing retinal detachment.METHODS: The clinical data of 54 eyes in 54 cases of long standing retinal detachment treated by the minimal scleral buckling in our hospital during January 2014 to September 2018 were analyzed retrospective. Patients were followed up for 6mo. The rate of postoperative retinal reattachment, the best corrected visual acuity(BCVA), intraocular pressure, eye axis and astigmatism were observed. According to the preoperative time of retinal detachment, retinal detachment range, macular involvement or not and presence of PSF or not, the improvement of postoperative BCVA were analyzed.RESULTS: The retina reattached in 49 eyes(91%)after primary operation. Postoperative persistent subretinal fluid was observed in 29 eyes of them by optical coherence tomography. At the last follow up, BCVA increased in 12 eyes(22.2%), remained unchanged in 38 eyes(70.4%), and decreased in 4 eyes(7.4%).The preoperative time of retinal detachment, retinal detachment range, macular involvement or not and presence of PSF or not had an impact on the postoperative recovery of BCVA.CONCLUSION: The minimal sclera buckling surgery is an effective method to treat long standing retinal detachment. But postoperative visual acuity recovery is related to many factors.

Macular recovery after surgery for retinal detachment (RD) depends on preoperative and postoperative predictive factors. Preoperative visual acuity is the main preoperative factor correlating positively with good macular recovery. Preoperative factors, which influence macular recovery negatively, include duration of macular detachment, height of macular detachment and vitreomacular traction. Postoperative factors, which influence macular recovery negatively, include cystoid macular oedema, epiretinal membranes, retinal folds, subretinal retinal pigment epithelium (RPE) migration and persistent subretinal fluid on optical coherence tomography (OCT). According to the latest available data, a detached macula has to be reattached within 5 days to optimize functional recovery. However, new therapeutic options such as exposure to hyperoxia or different growth factors may help to improve the final visual outcome in the presence of an already detached macula. [ABSTRACT FROM AUTHOR]

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