Author: Amirthan Sothivannan (Canada)
Co-authors: Arshia Eshtiaghi, Arjan Dhoot, Marko M. Popovic, Rajeev H. Muni, Peter J. Kertes
Visual outcomes of surgical repair for rhegmatogenous retinal detachment (RRD) may be influenced by the time from presentation to surgical repair. The conventional approach recommends treating macula-on RRDs urgently and allows for macula-off RRDs to be delayed for several days. However, recent studies cast doubts on whether this approach leads to optimal results. This meta-analysis investigates the relationship between time to surgical repair and visual acuity (VA) outcomes for macula-on and macula-off RRDs.
We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to September 2020. We included controlled studies that recorded both the time to RRD repair and VA outcomes. Studies published in languages other than English, unpublished studies, case reports, narrative reviews, editorials, and articles with repeat data from the same patient sample were excluded. We conducted a random-effects meta-analysis using an empirical Bayesian estimator for all outcomes. Sensitivity analyses included leave-one-out and influence analyses for all outcomes. Continuous outcomes were reported as mean difference (MD) with 95% confidence interval [CI], and RR outcomes were reported as a pooled RR with 95% CI. Primary outcomes were final VA, change in VA (∆VA), and relative risk (RR) of final VA >0.4 logMAR between macula-off RRD repair in 1-3 versus 4-7 days and macula-on repair in ≤24 versus >24 hours. Secondary outcomes examined other timepoints and RR of reattachment success for macula-on repair in ≤24 hours versus >24 hours.
39 articles (1 RCT, 38 observational) reported on 7030 patients. Macula-off RRD repair in 1-3 days was superior to 4-7 days for final VA (MD [95% CI]: -0.06 [-0.09, -0.03] logMAR, p<0.001), but was not different for ∆VA (0.03 [-0.18, 0.25], p>0.05) or for the RR of VA <0.4 logMAR (RR [95% CI]: 1.28 [0.99, 1.67], p=0.06). Macula-off repair in ≤7 days was superior to >7 days for final VA (-0.20 [-0.30, -0.10], p<0.001), ∆VA (-0.29 [-0.46, -0.13], p<0.001), and RR of VA >0.4 logMAR (1.34 [1.01, 1.78], p<0.05). Macula-off repair in ≤10 days was superior to >10 days for final VA (-0.48 [-0.65, -0.31], p<0.001) and ∆VA (-0.42 [-0.66, -0.17], p<0.001). There was no difference between ≤15 days and >15 days for final VA (-0.06 [-0.23, 0.11], p>0.05) or ∆VA (-0.02 [-0.43, 0.38], p>0.05). Macula-on RRD repair in ≤24 hours was superior to >24 hours for final VA (-0.02 [-0.03, -0.01], p<0.01), but was not different for ∆VA (0.00 [-0.02, 0.02], p>0.05) or the RR of VA <0.4 logMAR (1.09 [0.91, 1.31], p>0.05). Reattachment success was similar between macula-on repair in ≤24 hours and >24 hours (RR [95% CI]: 0.97 [0.90, 1.03], p<0.05).
Macula-off and macula-on RRDs have the best visual outcomes when repaired in ≤3 days and ≤24 hours, respectively. Further studies should aim to investigate whether the relationship between time to RRD repair and visual outcome is affected by the type of repair performed or endotamponade used.
MMP: Financial support (to institution) – PSI Foundation. PJK: Advisory board – Roche, Novartis, Alcon, Bayer, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx. RHM: Advisory board- Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.