Characteristics of rhegmatogenous retinal detachment and their relationship to visual outcome

Abstract

Aims: To examine pre-operative characteristics of rhegmatogenous retinal detachment (RRD) and their relationship to visual acuity (VA) following surgery.

Methods: Review of prospectively completed electronic database. Baseline characteristics, retinal drawings and outcomes were analysed.

Results: In all, 847 eyes from 847 patients with a mean age of 62.2 years, 60% males, and 56% right eyes were studied. Mean follow-up was 9.6 months. Preoperative VA correlated with final VA (r(2)=0.21, P<0.0001). Median postoperative VA was 6/9 (Logmar 0.18, quartiles=0.0-0.48) and was significantly related to anatomical success: 70.15% achieved 0.18 or better with fully attached retina and primary success, whereas only 8.33% achieved this when the retina was not fully attached at final follow-up (failure) (P<0.0001). Univariate analysis found multiple variables associated with achieving 0.18 postoperative vision, however, multivariate analysis revealed only primary anatomical success with surgery; absence of proliferative vitreo-retinopathy (PVR), better-presenting VA and fewer quadrants of detachment were associated with a better visual outcome (r(2)=0.26, P<0.0001). Patients with a clinically attached fovea achieved better vision than patients with a clinically detached fovea, independent of the visual loss duration. With foveal detachment however, postoperative VA was better in patients with 1-3 days of visual loss compared with 4-6 days (P=0.013).

Conclusions: Failure of primary surgery, PVR, extensive RRD and poor-presenting VA are risk factors for poorer visual outcome following surgery for RRD. Fovea off RRD at presentation achieved poorer postoperative VA than fovea attached and visual outcome was poorer when there was a longer duration of visual symptoms.

Figure 1

Proportions of patients with levels of Snellen acuity preoperatively and postoperatively, CF=counting fingers, HM=hand movements, LP=light perception.

Figure 2

Relationship of preoperative VA (ae va) to postoperative acuity (ae fu va), in LogMAR units. The correlation between preoperative and postoperative acuity is significant with P<0.0001 and r²=0.21.

Figure 3

Visual acuities after surgery (ae fu va) in fovea on patients and fovea off patients with 1, 2, 3, 4, 5, 6, 7–13 (7), 14–20 (14), or ≥21 days (21) duration of visual loss.