Rhegmatogenous retinal detachment (RRD) is the most common retinal emergency that threatens vision without surgery. Research has shown that photoreceptor cell death is immediately induced as early as 12 hours and peaks at around 2–3 days after RRD, lead to irreversible vision decline. While many preoperative and intraoperative prognostic factors have been studied, the strongest and most consistent predictors of visual outcomes were preoperative visual acuity and the status of the macula. Prompt surgery in eyes with macula-on RRD can prevent foveal detachment. As for eyes with macula-off­, reattaching the retina as soon as possible is the key to saving the greatest amount of visual function. Therefore, most developed countries have defined RRD as an ophthalmic emergency and implemented emergency surgery.
In this study, Ziye Chen et al retrospectively compared the effects of the implementation of emergency surgical patterns and the conventional inpatient surgical patterns on RRD in order to provide clinical evidence to promote the emergency surgical pattern for RRD both in China and in other countries.
They reviewed the electronic medical records of 346 patients (348 eyes) who underwent surgical repair of RRD at the Zhongshan Ophthalmic Center in Southern China. A total of 140 patients (140 eyes) in the routine inpatient surgery group were collected at the fundus disease department between January 2019 and December 2019, and 206 patients (208 eyes) in the emergency surgery group were collected at the ophthalmic emergency department between January 2021 and December 2021.
The preoperative BCVA (logMAR) of the emergency surgery group and the inpatient surgery group were 1.0 (0.4–1.7) and 1.4 (0.7–1.7), respectively, with significant di­fferences between groups (P < 0.001). However, patients had a shorter time to presentation (7 days vs. 21 days, P < 0.001), shorter treatment interval (2 days vs. 12 days, P < 0.01), and significantly better postoperative BCVA (logMAR 0.5 vs. logMAR 1.0, P < 0.001) in the emergency surgery group than in the inpatient surgery group. There was no significant diff­erence in primary anatomical success between the two groups (P ­ 0.802). The median follow-up for the emergency surgery group and the inpatient surgery group were 6.08 months and 6.2 months, respectively, with no significant di­fferences (P > 0.05).
In present study, 161 eyes (77.40%) underwent surgery within 72 h, and the median treatment interval was only 2 (1–3) days in the emergency surgery group. While in the inpatient surgery group, there were only 14 eyes (10.00%) that underwent surgery within 72 h, and the median treatment interval was 12 (8–19) days. Under the traditional inpatient surgery pattern, long queues for surgery with wait times of nearly two weeks or even one month definitely delay the treatment and affect postoperative visual function. However, patients with emergency surgery patterns could receive prompt surgery with a shorter treatment interval, which would contribute to a better visual outcome.
The results of this study confirmed that patients with RRD who underwent emergency surgery achieved significantly improved visual outcomes. Therefore, surgical intervention for RRD in an emergency setting is worthy and valuable enough to be promoted in order to get better postoperative visual function.
Source: Ziye Chen , Kai Gao , Kunbei Lai; Hindawi Journal of Ophthalmology Volume 2022, Article ID 4240225, 6 pages https://doi.org/10.1155/2022/4240225