PREOPERATIVE AND EARLY POSTOPERATIVE FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER MACULAR-OFF RETINAL DETACHMENT SURGERY.
Objective: To evaluate preoperative and early postoperative factors associated with changes in visual acuity in patients with macula-off rhegmatogenous retinal detachment.
Methods: A retrospective review of 59 eyes from 59 patients who underwent pars plana vitrectomy and silicone oil tamponade for macula-off rhegmatogenous retinal detachment. Preoperative and early postoperative characteristics were analyzed using the classification and regression tree analysis.
Results: The baseline preoperative best-corrected visual acuity improved from 1.67 ± 0.97 the logarithm of the minimum angle of resolution to 0.21 ± 0.22 the logarithm of the minimum angle of resolution at the final visit. Central foveal thickness and best-corrected visual acuity showed significant increases from 1 week postsurgery onward. The mean Central foveal thickness significantly increased from 136.97 ± 40.17 µ m to 192.54 ± 34.09 µ m ( P < 0.001). The percentage of eyes with integrated external limiting membrane and ellipsoid zone was progressively increased from 45.76% and 10.17% to 98.31% and 71.19%, respectively ( P < 0.001). Best-corrected visual acuity at 1 week after surgery, external limiting membrane integrity, preoperative intraretinal cysts, and macula-off duration were significantly associated with final visual recovery after surgery. In particular, patients whose best-corrected visual acuity at 1 week were not more than 0.7 logarithm of the minimum angle of resolution, without preoperative intraretinal cysts, and operated on within 15 days of initial symptoms had the best predicted final vision of 0.006 logarithm of the minimum angle of resolution.
Conclusions: The first week postoperative best-corrected visual acuity is the most powerful predictor for final best-corrected visual acuity. External limiting membrane integrity, intraretinal cysts, and macula-off duration are also significantly associated with final visual recovery.