title: Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature.
abstract: OBJECTIVE
  To systematically review the influence of the lag time between macula-off retinal detachment and surgical intervention on postoperative visual acuity as main outcome measure.
  
  
  METHODS
  Systematic review and meta-analysis of articles published from 1995 to October 2013 of patients with macula-off retinal detachment and treated with scleral buckling or pars plana vitrectomy. Eligible data were pooled in a meta-analysis, analyzing the odds ratio between different durations of ≤ 3, ≤ 4, ≤ 7, and ≤ 10 days, comparing a final visual acuity of ≤ 0.4 logMAR with >0.4 logMAR, using a random-effects model. Last, the number needed to treat was calculated.
  
  
  RESULTS
  Fourteen articles were eligible, of which 9 studies contained data that were suitable for meta-analysis. Patients who were operated with scleral buckling (n = 602) within 3 days since macular detachment had a statistically significant better chance of reaching a final visual acuity of 0.4 logMAR or better compared with a longer duration of macular detachment, with an odds ratio for ≤ 3 days versus 4 days to 7 days of 2.86 (95% confidence interval, 1.37-5.99) and an odds ratio for ≤ 3 days versus >3 days of 3.09 (95% confidence interval, 1.56-6.12), and with a number needed to treat of 4. For pars plana vitrectomy, the limited amount of data precluded a meta-analysis with substantial results.
  
  
  CONCLUSIONS
  This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome.
authors.affiliation: Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Erik M
authors.initials: EM
authors.lastname: van Bussel
authors.forename: Rikkert
authors.initials: R
authors.lastname: van der Valk
authors.forename: Ward R
authors.initials: WR
authors.lastname: Bijlsma
authors.forename: Ellen C
authors.initials: EC
authors.lastname: La Heij
mesh_terms: D006801:Humans; D008266:Macula Lutea / Q000601:surgery*; D012163:Retinal Detachment / Q000503:physiopathology / Q000601:surgery*; D012591:Scleral Buckling; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy