Influence of the Baseline Morphologic Stage on Postoperative Visual Acuity and Metamorphopsia Outcomes in Fovea-off Rhegmatogenous Retinal Detachment

Purpose: To evaluate the association between the baseline morphologic stage of rhegmatogenous retinal detachment (RRD) and postoperative visual acuity and metamorphopsia. Methods: This retrospective study included 39 consecutive patients with primary fovea-off RRDs who underwent scleral buckling at the Eye and ENT Hospital of Fudan University between 2018 and 2023. Optical coherence tomography, best-corrected visual acuity (BCVA), and M-CHARTS were assessed at baseline and at 1, 3, 6, and 12 months postoperatively. Results: Baseline morphologic stage was 1 and 2 in 41%, 3 in 21%, 4 in 15%, and 5 in 23% of patients. Advanced morphologic stage was associated with worse BCVA (P = 0.001, 0.001, 0.008, 0.002, and 0.002) and greater M-CHARTS scores (P = 0.033, 0.004, 0.001, 0.003, and 0.005) at baseline and at 1, 3, 6, and 12 months postoperatively, respectively. After adjusting for covariates, the partial correlation coefficients between BCVA at baseline and at 1, 3, 6, and 12 months postoperatively were significantly positive (P = 0.001, 0.001, 0.002, and 0.005, respectively), as were the partial correlation coefficients between preoperative vertical M-CHARTS scores and scores at 1, 3, 6, and 12 months postoperatively (P < 0.001, 0.001, 0.001, and 0.027, respectively). The M-CHART scores at 3, 6, and 12 months were significantly better in stages 1, 2, and 3 versus stage 4 (P = 0.002, 0.003, and 0.002, respectively). Conclusions: Postoperative BCVA and metamorphopsia deteriorated significantly at all timepoints in patients with more advanced baseline morphologic stages, highlighting the need for earlier intervention in fovea-off RRD.