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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*

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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