From the Guidelines
Macula off retinal detachment is a serious ophthalmologic emergency requiring immediate surgical intervention, and patients should be referred to a retinal specialist within 24 hours for surgical repair, as visual outcomes worsen with increased duration of macular detachment. The primary goal of treatment is to allow patients to maintain their abilities to read, work, drive, care for themselves, and maintain their quality of life 1.
Key Considerations
- The rate of successful reattachment is higher and the visual results are better when repaired early and especially before the RRD involves the macula 1.
- Nearly all patients with a symptomatic clinical RRD will progressively lose vision unless the detachment is repaired, and currently, more than 95% of uncomplicated RRDs can be successfully repaired, although more than one procedure may be required 1.
- The primary surgical options include pneumatic retinopexy, scleral buckling, or vitrectomy, with the specific approach determined by the characteristics of the detachment.
Preoperative Care
- While awaiting surgery, patients should maintain head positioning as directed by their ophthalmologist to minimize further detachment.
- Symptoms include sudden vision loss, flashes of light, floaters, and a curtain-like shadow in the peripheral vision.
Postoperative Care
- Visual recovery after repair is often incomplete, with final visual acuity depending on the duration of macular detachment before repair.
- Patients with repaired retinal detachments require long-term follow-up as they have an increased risk of developing detachments in the fellow eye or re-detachment in the affected eye.
Prognosis
- The goal of RRD treatment is to allow patients to maintain their quality of life, and early diagnosis and treatment are crucial to achieving this goal 1.
From the Research
Macula Off Retinal Detachment Treatment Options
- Scleral buckling and primary vitrectomy are two common treatment options for macula-off rhegmatogenous retinal detachment, with no significant differences in single-procedure reattachment incidence, final success incidence, and incidence of postoperative proliferative vitreoretinopathy development 2
- Pneumatic retinopexy, scleral buckling, and vitrectomy surgery are also used in the management of pseudophakic retinal detachments, with good anatomic and visual results 3
Predictors of Visual Recovery
- Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment are predictors of postoperative visual recovery in patients with macula-off retinal detachment 2
- Patients with a single retinal break and better preoperative logMAR VA are more likely to achieve a postoperative VA of 20/40 or better 4
- Duration of central vision loss prior to surgical repair is not significantly associated with postoperative VA in some studies 4, but other studies suggest that even short durations of macular detachment can affect final visual acuity 5
Comparison of Treatment Outcomes
- Scleral buckling alone may achieve visual outcomes that are at least comparable with pars plana vitrectomy (PPV) ± scleral buckling in the management of macula-off primary rhegmatogenous retinal detachment 6
- Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment 2
Importance of Prompt Treatment
- Reductions in final visual acuity can occur even within the first 3 days after a macula-off retinal detachment, highlighting the importance of prompt treatment 5
- Interventions that shorten the duration of macular detachment, including those occurring within the first 3 days, may result in improved long-term visual acuity outcomes 5