title: Urgent Vitrectomy/Phacovitrectomy for Bullous Macula-Off Retinal Detachment: Implications for Optimal Timing of Surgery.
abstract: OBJECTIVE
  Recently, an increasing number of ophthalmologists are using vitrectomy as the first line of treatment for retinal detachment (RD). The purpose of the present study was to determine the cutoff time of duration of macular detachment (DMD) after which postoperative best corrected visual acuity (BCVA) decreases sharply in eyes treated with primary vitrectomy.
  
  
  METHODS
  This was a retrospective, noncomparative, interventional case series.
  
  
  METHODS
  Fifty-six eyes with macula-on RD and 126 eyes with bullous macula-off RD.
  
  
  RESULTS
  Mean postoperative BCVA showed a statistically significant decrease when DMD exceeded 10 days (P = 0.009) with vitrectomy/phacovitrectomy as the primary mode of treatment, which was comparable to previous studies using scleral buckling. Approximately 90% (88%-93%) of eyes achieved a postoperative 20/40 BCVA when DMD was 2 days or less, after which the ratio decreased (P = 0.008) but plateaued around 40% until DMD reached 10 days. On the other hand, only 5.6% of (7/126) eyes with DMD of 3 days or less achieved a postoperative 20/20 BCVA.
  
  
  CONCLUSIONS
  As with scleral buckling, the mean postoperative BCVA in eyes with bullous macula-off RD treated with primary vitrectomy/phacovitrectomy dropped significantly when DMD exceeded 10 days. To achieve a good postoperative visual acuity (20/40), urgent surgery with a DMD of 2 days or less is desired. Operative repair within this period, rather than outright emergency surgery, may be appropriate for most cases.
authors.affiliation: From the *Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto; and †Department of Ophthalmology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kikushima
authors.forename: Akira
authors.initials: A
authors.lastname: Imai
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Miyahara
authors.forename: Toru
authors.initials: T
authors.lastname: Kurokawa
authors.forename: Toshinori
authors.initials: T
authors.lastname: Murata