Elsevier

Ophthalmology

Volume 109, Issue 1, January 2002, Pages 146-152
Ophthalmology

The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments

Presented at the American Academy of Ophthalmology annual meeting, Dallas, Texas, October 2000.
https://doi.org/10.1016/S0161-6420(01)00886-7Get rights and content

Abstract

Purpose

To present a current series that determined the effect of duration of macular detachment (DMD) and patient age on postscleral buckle (SB) visual acuity (VA) and anatomic results.

Design

Retrospective, noncomparative, observational case series.

Participants

Ninety-four consecutive patients (94 eyes) with primary, uncomplicated, macula-off retinal detachments, a preoperative VA of 20/200 or worse, and a precise history of when macular function was lost.

Intervention

Standard explant scleral buckle technique performed by multiple surgeons.

Main outcome measures

Visual acuity, anatomic reattachment, and proliferative vitreoretinopathy.

Results

Visual acuity after SB of 20/40 or better was seen in 71% of eyes with a DMD of 10 days or fewer, 27% of eyes with a DMD of 11 days to 6 weeks, and 14% of eyes with a DMD of more than 6 weeks. Eyes achieved a mean VA after SB of 20/41 after a DMD of 10 days or fewer, 20/121 after a DMD of 11 days to 6 weeks, and 20/178 after a DMD of more than 6 weeks. No decrease in VA was seen within the 1- to 10-day period or the 11 days to 6 week period of DMD. Patients 60 years of age or less achieved a mean VA after SB of 20/47 compared with 20/81 for patients between 61 to 75 years of age and 20 of 96 in patients more than 76 years of age. Duration of macular detachment and patient age had no statistically significant effect on final anatomic reattachment after SB, reoperation rate, or proliferative vitreoretinopathy.

Conclusions

Eyes with primary, uncomplicated, macula-off retinal detachment repaired with SB achieve excellent postoperative VA if repaired within the first 10 days of macular detachment. These results are better than the VA in eyes repaired after 11 days to 6 weeks and more than 6 weeks of macular detachment. Patients 60 years of age and younger obtained better postoperative VA than older patients. Duration of macular detachment and patient age did not significantly effect anatomic outcomes.

Section snippets

Materials and methods

We retrospectively reviewed the records of 324 consecutive patients with RRD who sought treatment from four surgeons (TH, GW, AR, BG) during a 2-year period (June 1, 1996–July 1, 1998). We used extensive inclusion criteria to achieve the patient database for this series. All included eyes had a primary, macula-off RRD with a VA of 20/200 or less. Only eyes in patients who could time the onset of significant visual loss accurately to a specific 24-hour period were considered. Eyes in patients in

Results

All 94 patients could time the onset of significant visual loss to a 1-day period if they were included in the acute group and to a 3-day period if included in the subacute and chronic groups. Eyes from 56 men and 38 women were evaluated. The mean patient age was 61.5 years (range, 15–92 years), with 42 patients 60 years of age or younger, 36 patients between 61 and 75 years of age, and 16 patients more than 75 years of age. Before surgery, 52 eyes were phakic, 2 were aphakic, and 40 were

Discussion

Scleral buckling remains a primary surgical technique for the repair of uncomplicated RRD despite the development and acceptance of other options in recent years.1, 28, 29 Numerous studies have correlated a wide array of preoperative factors with both favorable and poor anatomic and VA outcomes after SB.7, 8, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 30 Burton and Lambert30 isolated 22 factors that may affect operative results, none of which could be altered readily by the

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