title: Quick Referral and Urgent Surgery to Preempt Foveal Detachment in Retinal Detachment Repair.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: From the *Department of Ophthalmology, Shinshu University School of Medicine; and †Department of Ophthalmology, National Hospital Organization, Matsumoto Medical Center, Matsumoto, Nagano, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kikushima
authors.forename: Akira
authors.initials: A
authors.lastname: Imai
authors.forename: Takao
authors.initials: T
authors.lastname: Hirano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Iesato
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Toriyama
authors.forename: Masako
authors.initials: M
authors.lastname: Murata
authors.forename: Toshinori
authors.initials: T
authors.lastname: Murata