Purpose: The primary goal of this study was to investigate the functional results after scleral buckling (SB) surgery in macula-off rhegmatogenous retinal detachment (RRD), with more or less than 7 days’ duration of macular detachment (DMD). The secondary outcome measure was to determine the long-term functional results in these two groups 5 years after SB surgery. Methods: The retrospective studies included 96 eyes of 96 patients with primary, uncomplicated, macula-off RRD. Two studies, one with a short-term follow-up and one with a long-term follow-up, were performed, and in both studies the eyes were divided into two groups according to the DMD. In study I, 96 patients were divided into DMD ≤7 days (n = 73) and prolonged DMD more than 7 days (n = 23) with a postoperative follow-up of at least 3 months (mean 43.5 months). In a subgroup analysis, patients were divided into acute DMD ≤3 days (n = 37) and subacute DMD ≧4 days and ≤7 days (n = 36). Study II included 47 patients with a follow-up of at least 5 years (mean 6 years). All patients were divided into(subacute) DMD ≤7 days (n = 36) and (prolonged) DMD of >7 days (n = 11). Additional preoperative predictive factors including DMD, preoperative visual acuity (VA) and patients’ age at the time of the RRD were correlated with the postoperative VA. Results: In study I, the mean final VA was significantly better (0.45) after a DMD of less than or equal to 7 days, compared to patients with a DMD of more than 7 days (0.22; Student’s t test, p = 0.02). VA ≧0.4 was achieved in 68% with a subacute DMD compared to 52% in patients with prolonged DMD (χ2 test, p < 0.001). However, the postoperative VA (0.48 ± 0.09) in eyes with DMD of 1–3 days was similar (0.42 ± 0.07) to eyes with DMD of 4–7 days (Student’s t test, p = 0.455). We divided the 96 patients into 2 groups according to a preoperative VA. Eyes with a preoperative VA ≤0.1 (n = 62) had a significantly lower final VA compared to eyes with a preoperative VA >0.1 (n = 34; Student’s t test, p < 0.001). Patients 75 years of age or younger were more likely to achieve a VA of 0.4 or better after SB surgery than older patients (more than 75 years; χ2 test, p = 0.008). In study II, VA improved (by a mean of 1.60 ± 0.02 lines) during the follow-up period from 0.32 ± 0.08 at the 3-month follow-up to 0.46 ± 0.10 at the 5-year follow-up. Eyes with a subacute DMD had a significantly better VA than eyes with a prolonged DMD (Student’s t test, p = 0.004). Patients aged 75 years or less were more likely to achieve a VA of 0.4 or better than patients older than 75 (χ2 test, p = 0.003). Conclusion: The time point of SB surgery has no statistical impact on the final visual recovery in patients with an acute primary macular-off RRD of less than or equal to 7 days. A delay of SB surgery within this time frame does not contribute to an impaired final visual outcome. There was no evidence, that primary macula-off RRDs are emergencies, which cannot wait for a systemic evaluation of the RRD and surgical treatment at the next available scheduled day. A preoperative VA of more than 0.1 and patients’ age under 60 years at presentation had an additional prognostic value on the final outcome. Surgeons should be aware that visual function after reattachment may continue to improve over a long period. This study provides useful guidelines for the clinical management of macula-off RRD and the assessment of potential visual recovery in patients after successful SB surgery.

1.
Hartz AJ, Burton TC, Gottlieb MS, McCarty DJ, Williams DF, Prescott A, Klein P: Outcome and cost analysis of scheduled versus emergency scleral buckling surgery. Ophthalmology 1992;99:1358–1363.
2.
Grizzard WS, Hilton GF, Hammer ME, Taren D: A multivariate analysis of anatomic success of retinal detachments treated with scleral buckling. Graefes Arch Clin Exp Ophthalmol 1994;232:1–7.
3.
Sharma T, Challa JK, Ravishankar KV, Murugesan R: Scleral buckling for retinal detachment: predictors for anatomic failure. Retina 1994;14:338–343.
4.
Burton TC: Recovery of VA after retinal detachment involving the macula. Trans Am Ophthalmol Soc 1982;80:475–497.
5.
Ross WH, Kozy DW: Visual recovery in macula-off rhegmatogenous retinal detachments. Ophthalmology 1998;105:2149–2153.
6.
Wilkinson CP: Visual results following scleral buckling for retinal detachments sparing the macula. Retina 1981;1:113–116.
7.
Ross WH, Stockl FA: Visual recovery after retinal detachment. Curr Opin Ophthalmol 2000;11:191–194.
8.
Kusaka S, Toshino A, Ohashi Y, Sakaue E: Long-term visual recovery after scleral buckling for macula-off retinal detachments. Jpn J Ophthalmol 1998;42:218–222.
9.
Kondo K, Takai K, Kimata M: Surgical outcome in rhegmatogenous retinal detachment during the past five years in our institution. Jpn Rev Clin Ophthalmol 1991;85:236–241.
10.
Isernhagen RD, Wilkinson CP: Recovery of VA following the repair of pseudophakic retinal detachment. Trans Am Ophthalmol Soc 1988;86:291–306.
11.
Friberg TR, Eller AW: Prediction of visual recovery after scleral buckling of macula-off retinal detachments. Am J Ophthalmol 1992;114:715–722.
12.
Hassan TS, Sarrafizadeh R, Ruby AJ, Garretson BR, Kuczynski B, Williams GA: The effect of DMD on results after the scleral buckle repair of primary, macula-off retinal detachments. Ophthalmology 2002;109:146–152.
13.
Ferris FL III, Kassoff A, Brensnick GH, Bailer I: New visual acuity charts for clinical research. Am J Ophthalmol 1982;94:91–96.
14.
Wilkinson CP, Rice TA: Results of retinal reattachment surgery; in Wilkinson CP, Rice TA (eds): Michels Retinal Detachment, ed 2. St Louis, Mosby, 1997, pp 935–977.
15.
Wilkinson CP: Scleral buckling techniques: a simplified approach; in Guyer DR, Yannuzii LA, Chang S, et al (eds): Retina – Vitreous – Macula. Philadelphia, Saunders, 1999, pp 1248–1271.
16.
Williams GA, Aaberg TM: Techniques of scleral buckling; in Ryan SJ (ed): Retina. St Louis, Mosby, 2001, pp 2010–2046.
17.
Michels R, Wilkinson CP, Rice TA: Results of retinal reattachment surgery; in Michels R, Wilkinson CP, Rice TA (eds): Retinal detachment. St Louis, Mosby, 1990, pp 917–958.
18.
Machemer R: Experimental retinal detachment in the owl monkey. IV. The reattached retina. Am J Ophthalmol 1968;66:1075–1091.
19.
Burton TC, Lambert RW Jr: A predictive model for visual recovery following retinal detachment surgery. Ophthalmology 1978;85:619–625.
20.
Yasukawa T, Fukuda T, Kishimoto M, Ogura Y: Prediction of post-operative VA in retinal detachment with macular involvement. Nippon Ganka Gakkai Zasshi 1995;99:318–322.
21.
Yazici B, Gelisken O, Avci R, Yucel A: Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer. Br J Ophthalmol 2002;86:278–281.
22.
Anderson DH, Stern WH, Fisher SK, Erickson PA, Borgula GA: Retinal detachment in the cat: the pigment epithelial photoreceptor interface. Invest Ophthalmol Vis Sci 1983;24:906–926.
23.
Anderson DH, Stern WH, Fisher SK, Erickson PA, Borgula GA: The onset of pigment epithelial proliferation after retinal detachment. Invest Ophthalmol Vis Sci 1981;21:10–16.
24.
Anderson DH, Guerin CJ, Erickson PA, Stern WH, Fisher SK: Morphological recovery in the reattached retina. Invest Ophthalmol Vis Sci 1986;27:168–183.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.