![]() ![]() Only one case had superonasal RRD resulting in macula-off RRD. In Kontos’ study assessing change in macular status between diagnosis and surgery, 10/930 patients progressed from macula-on to macula-off RRD, and the majority (9/10) had superotemporal detached retinal breaks. foveal detachment) being less than 72 h.Ī careful assessment of RRD characteristics at presentation is important to determine the speed of RRD progression. The most important modifiable risk factor to achieve better visual results was the duration of central visual loss (i.e. in their UK database study of over 2000 eyes with macula-off RRD. These findings were echoed by Yorston et al. They showed that final vision was significantly better if the retina was reattached 1–3 days after loss of vision compared to 4–6 days. examined 325 macula-off RRD patients with primary success and no proliferative vitreoretinopathy. However, several recent studies have yielded different results. This led to a policy of treating macula-off RRD with less urgency. ![]() Both of these studies were based on scleral buckling. Later, Ross and Kozy reported equal visual outcomes whether RRD repair occurred 1–2 days, 3–4 days or 5–7 days after macular detachment. He found patients with macular detachment of ≤9 days duration were significantly more likely to regain a final vision of 6/15 or better than those with macula detachment of 10–19 days, or ≥20 days ( p < 0.05). In 1982, Burton reported visual outcome after RRD repair was generally dependent on the duration of macular involvement. The question we address here is whether the pre-operative status of the macula is still the most important factor determining the urgency of RRD repair. Although it continues to be standard practice to differentiate between macula-on (fovea-on) and macula-off (fovea-off) detachment, it would be valuable to identify factors indicating a high risk of rapid progression of a macula-on RRD. have recently reignited the debate on timing of surgery with their work on the effect of duration of macular detachment on visual recovery. Patients presenting with a macula-off detachment have therefore been considered lower priority. The rationale for this was based on the opinion that permanent functional damage occurred once the macula had detached, and therefore surgery should be performed within 24 h for a macula-on detachment. Traditionally, the timing of rhegmatogenous retinal detachment (RRD) repair has been dependent on a binary assessment-whether the macula is detached or not. ![]()
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