Comparative Analysis of Rhegmatogenous Retinal Detachment Repair with or without Associated Macular Hole

Purpose: To assess the anatomic and functional outcomes in primary uncomplicated rhegmatogenous retinal detachment (RRD) compared to RRD associated with macular hole (MH). Methods: This retrospective cohort study included 1303 eyes with RRD and 30 eyes with MH-RRD operated on between 2014 and 2018 at a single tertiary center. Main outcomes were single-surgery anatomic success (SSAS), MH closure and final pinhole visual acuity (PHVA). Results: Of the 1333 patients, 867 (65%) were male, and median [Q1, Q3] age was 63 [57, 70]. Most of these were macula-off detachments (n=764, 57%) with a higher proportion in MH-RRD (n=26, 87%) than primary RRD (n=738, 57%) (p=0.004). Baseline VA was lower in MH-RRD (p<0.001). Postoperative PHVA at three months was 0.30 [0.18, 0.54] in primary RRD vs. 0.85 [0.60, 1.30] in MH-RRD (p<0.001); final PHVA was 0.18 [0.10, 0.40] vs. 0.68 [0.40, 0.90] (p<0.001) respectively. Primary MH closure was achieved in 27 (90%) MH-RRD cases; at final follow-up, all 30 MH-RRDs had attached retinas with one persistent MH. MH presence was not significantly associated with SSAS (p=0.391), while increasing age was a negative predictor of SSAS (p=0.008). Male sex (p<0.001), SF 6 tamponade (p<0.001), SSAS (p<0.001), and longer follow-up (p<0.001) were positive predictors of final PHVA. Conclusion: SSAS did not significantly differ between the two groups though the small MH-RRD sample may have contributed to this. Functional outcomes were poorer in MH-RRD, likely due to more macula-off RRD, more retinal breaks, occasional MH closure failure and residual sequelae related to the MH.