Impact of Duration of Macula-Off Retinal Detachment on Visual Outcome

In Brief Purpose: To systematically review the influence of the lag time between macula-off retinal detachment and surgical intervention on postoperative visual acuity as main outcome measure. Methods: Systematic review and meta-analysis of articles published from 1995 to October 2013 of patients with macula-off retinal detachment and treated with scleral buckling or pars plana vitrectomy. Eligible data were pooled in a meta-analysis, analyzing the odds ratio between different durations of ≤3, ≤4, ≤7, and ≤10 days, comparing a final visual acuity of ≤0.4 logMAR with >0.4 logMAR, using a random-effects model. Last, the number needed to treat was calculated. Results: Fourteen articles were eligible, of which 9 studies contained data that were suitable for meta-analysis. Patients who were operated with scleral buckling (n = 602) within 3 days since macular detachment had a statistically significant better chance of reaching a final visual acuity of 0.4 logMAR or better compared with a longer duration of macular detachment, with an odds ratio for ≤3 days versus 4 days to 7 days of 2.86 (95% confidence interval, 1.37–5.99) and an odds ratio for ≤3 days versus >3 days of 3.09 (95% confidence interval, 1.56–6.12), and with a number needed to treat of 4. For pars plana vitrectomy, the limited amount of data precluded a meta-analysis with substantial results. Conclusion: This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome. This meta-analysis demonstrates that scleral buckling for macula-off retinal detachment should preferably be performed within 3 days duration. In addition, it showed that the chance for an acceptable visual outcome becomes less after more than 4, 7, and 10 days, suggesting that final visual acuity continues to deteriorate the longer the surgery is awaited.