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Quick Referral and Urgent Surgery to Preempt Foveal Detachment in Retinal Detachment Repair

Kikushima, Wataru MD*; Imai, Akira MD*; Hirano, Takao MD*; Iesato, Yasuhiro MD, PhD*; Toriyama, Yuichi MD*; Murata, Masako MD*†; Murata, Toshinori MD, PhD*

The Asia-Pacific Journal of Ophthalmology: May/June 2014 - Volume 3 - Issue 3 - p 141–145
doi: 10.1097/APO.0b013e3182a81240
Original Clinical Study

Purpose This study aimed to evaluate the consultation and referral pathway and benefit of urgent surgery within 24 hours of outpatient clinic presentation on increasing the ratio of eyes with fovea-on at surgery and visual outcomes in retinal detachment cases.

Design This is a retrospective, interventional case series.

Methods A total of 106 eyes underwent an operation for rhegmatogenous retinal detachment. Standard vitrectomy or explant scleral buckling was performed. The ratio of eyes with fovea-on at the time of operation, anatomical success rate, and postoperative best corrected visual acuity were measured.

Results Of the106 eyes, 46 (43.4%) already were fovea-off at initial eye clinic visit, and 9 eyes became fovea-off during referral. Consequently, 55 patients (51.9%) were fovea-off when presenting to our outpatient clinic. Retinal detachment was within 1 disc diameter of the fovea in 9 of 51 eyes with fovea-on at outpatient clinic presentation, but surgery within 24 hours spared 6 eyes from foveal involvement. The anatomical success rate of primary surgery was 98.8% (81/82 eyes) by vitrectomy and 83.3% (20/24 eyes) by scleral buckling. Postoperative best corrected visual acuity of the fovea-on group was significantly higher (mean [SD], −0.019 [0.22] logarithm of the minimal angle of resolution) than that of the fovea-off group (mean [SD], 0.32 [0.45] logarithm of the minimal angle of resolution; P = 0.002).

Conclusions More than half (51.9%) of our cohort had already been fovea-off by outpatient presentation. Therefore, efforts to urge patients to visit operating facilities promptly seem to be as important as the urgent surgeries themselves.

From the *Department of Ophthalmology, Shinshu University School of Medicine; and †Department of Ophthalmology, National Hospital Organization, Matsumoto Medical Center, Matsumoto, Nagano, Japan.

Received for publication April 23, 2013; accepted August 5, 2013.

The authors have no funding or conflicts of interest to declare.

Reprints: Toshinori Murata, MD, PhD, Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. E-mail: murata@shinshu-u.ac.jp.

© 2014 by Asia Pacific Academy of Ophthalmology
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