title: Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments.
abstract: OBJECTIVE
  To examine the effect of symptom duration on visual and anatomical outcomes following pars plana vitrectomy repair of primary macula-off rhegmatogenous retinal detachments.
  
  
  METHODS
  This is a retrospective, consecutive, interventional case series. All eyes underwent repair of macula-off rhegmatogenous retinal detachment with a 20-gauge, 23-gauge, or 25-gauge standard 3-port pars plana vitrectomy. Eyes with previous retinal surgery, giant retinal tear, Grade C or higher proliferative vitreoretinopathy, or less than 6 months of follow-up were excluded from the study. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the duration of macular detachment symptoms. The secondary outcomes studied were single surgery anatomical success and complication rates. Visual acuity analysis was performed on all eyes that were pseudophakic by the final follow-up visit.
  
  
  RESULTS
  Overall, 81 eyes of 81 patients met inclusion criteria, with a mean follow-up length of 55 months (range, 6-171 months) and mean duration of macular detachment symptom of 12 days (range, 1-64 days). The mean final BCVA was 20/40 (range, 20/20 to hand motion), with 70% (n = 57) of all patients obtaining 20/40 or better final BCVA. Patients with symptom duration of 6 days or less achieved better final BCVA (mean 20/25, n = 34) than patients with longer symptom duration (mean 20/50, n = 47) (t-test, P = 0.0030; α = 0.005). After 7 days of macular detachment, no significant difference was seen in final BCVA (t-test, P > 0.05). The overall single surgery anatomical success rate was 88% (71 of 81 eyes). There was no correlation between the single surgery anatomical success rate and duration of macular detachment symptom (Fisher's exact test, P > 0.10).
  
  
  CONCLUSIONS
  Primary pars plana vitrectomy repair results in good final visual outcome for patients with primary macula-off rhegmatogenous retinal detachments. Surgical repair within 6 days of the symptom onset yielded better visual outcomes. After 7 days, visual outcome was not affected by the timing of the surgical repair. Anatomical outcome following pars plana vitrectomy repair is not affected by symptom duration.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas; †Washington National Eye Center, Washington Hospital Center, Washington, District of Columbia; ‡The Retina Group of Washington, Chevy Chase, Maryland; and §Department of Ophthalmology, University of California at San Diego, San Diego, California.
authors.forename: James D
authors.initials: JD
authors.lastname: Kim
authors.forename: Hubert H
authors.initials: HH
authors.lastname: Pham
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lai
authors.forename: John W
authors.initials: JW
authors.lastname: Josephson
authors.forename: John R
authors.initials: JR
authors.lastname: Minarcik
authors.forename: Manfred
authors.initials: M
authors.lastname: Von Fricken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy