Quicker time to surgery affects VA outcomes in macula-on rhegmatogenous retinal detachments

At ASRS 2022, Sunir Garg, MD, FACS, discussed his talk entitled, “Impact of Delay in Repair of Rhegmatogenous Retinal Detachment: Real-World Outcomes from the IRIS Registry.”

Video transcript

Hi, I'm Sunir Garg from Wills Eye Hospital. So we presented our work using the IRIS registry to look at outcomes of primary rhegmatogenous detachment repair.

We've gotten really good at fixing the retina. Our surgical techniques have changed, but a couple of things limit visual acuity results. One is the macula status. And then the second is timing to surgery.

I think all of us would agree that if a patient has a macula-on detachment, we go to the operating room right away. But for macula-off detachments, the traditional teaching has been that we have all kinds of time to fix it. Whether you fix it today or whether you fix it in a week, it probably really didn't matter.

So we looked at over 300,000 eyes, and we divided them up into two groups. One group had good visual acuity that was 20/40 or better-- that was our surrogate for macula-on--and then a second group that had vision of 22/100 or worse. That was our surrogate for macula-off; we wanted to see how they did.

We did 30,000 eyes that were in the macula-on group and 14,000 eyes in the macula-off group. And we found some really interesting things regardless of repair.

There was about an 80% success rate for primary repair in both groups, that's sort of what we're accustomed to seeing. There was a slight benefit to doing early surgical repair in terms of initial surgical success.

But where things got really interesting is the visual acuity outcomes. As you might expect in the fovea-on group, if you fix them within a day, then on average division was about 20/40. And if you fix them after the day, the vision dropped to 20/45. Although that was a significant difference, from a clinical perspective, it probably didn't really matter.

But when we look at the fovea-off group, if we fix them within the first three days, on average, the vision was 20/76. And if they got repaired between days 47 division was 20/110. That was statistically significant and clinically really meaningful.

When we started digging a little bit deeper in the data, we have what we basically call a survival plot for vision. And if you take the fovea-off patients and you look at day one, day two, up to day seven, day three to four is where the break in vision occurs. But if you look at the overall trend, with each day of waiting, the visual acuity results are never as good as immediate repair. So this work adds to the growing body of literature that says that for macula-off patients, there may be an advantage both in terms of single surgeon success, as well as visual acuity outcomes to do the surgeries earlier rather than later.