Prognosis of Retinal Detachment
The prognosis for retinal detachment is excellent with surgical intervention, achieving anatomical success rates of 85-95%, though visual outcomes depend critically on whether the macula is involved at the time of repair. 1, 2
Surgical Success and Anatomical Outcomes
- More than 95% of uncomplicated rhegmatogenous retinal detachments (RRDs) can be successfully repaired, although more than one procedure may be required. 1
- Anatomical success rates range from 85% to 90% across different surgical techniques including scleral buckle, vitrectomy, or combination approaches. 2
- Spontaneous retinal reattachment is rare, meaning nearly all patients with symptomatic clinical RRD will progressively lose vision unless surgically repaired. 1
Visual Outcomes and Quality of Life
Early diagnosis and repair before macular involvement is the single most important factor determining visual prognosis. 1
- The rate of successful reattachment is higher and visual results are significantly better when repaired early, especially before the RRD involves the macula. 1
- The goal of RRD treatment is to allow patients to maintain their abilities to read, work, drive, care for themselves, and maintain their quality of life. 1
- The earlier a patient is seen by an ophthalmologist, the greater the chance that the macula remains attached, preserving visual acuity. 2
Prognosis Based on Type of Retinal Break
High-Risk Breaks (Poor Prognosis Without Treatment)
- At least 50% of untreated symptomatic retinal breaks with persistent vitreoretinal traction (horseshoe or flap tears) will lead to clinical retinal detachment. 1, 3
- However, prompt treatment by creating a chorioretinal adhesion around symptomatic tears reduces the risk of retinal detachment to less than 5%. 1, 3
Low-Risk Breaks (Favorable Prognosis)
- Asymptomatic operculated holes and atrophic round holes rarely lead to retinal detachment—in long-term studies following 74 eyes over 5-11 years, none progressed to retinal detachment. 1
- Only approximately 5% of eyes with asymptomatic horseshoe tears progress to retinal detachment. 1
Long-Term Considerations and Recurrence Risk
- Between 5% and 14% of patients found to have an initial retinal break will develop additional breaks during long-term follow-up. 3
- Patients with previous retinal detachment have a 10% increased risk of developing retinal detachment in the fellow eye. 4
- Vitrectomy is followed by lens opacification (cataract formation) in more than 70% of cases. 2
Common Pitfalls Affecting Prognosis
Delayed presentation is the primary modifiable factor worsening prognosis. 2
- Patients presenting with acute posterior vitreous detachment (PVD) and no retinal breaks have approximately 2% chance of developing retinal breaks in the following weeks, requiring vigilant follow-up. 3
- Without treatment, rhegmatogenous retinal detachment leads to blindness in the affected eye. 2
- Patient education about symptoms (flashes, floaters, peripheral visual field loss) improves the likelihood of prompt reporting, enhancing the opportunity for successful treatment and better visual outcomes. 3