Odwarstwienie siatkówki – Rokowania, prognozy i postęp choroby

Odwarstwienie siatkówki
Rokowania, prognozy i postęp choroby

Odwarstwienie siatkówki (OS) to oddzielenie neurosensorycznej warstwy siatkówki od nabłonka barwnikowego, co bez leczenia prowadzi do trwałej utraty wzroku. Nowoczesne metody chirurgiczne umożliwiają anatomiczne przyłożenie siatkówki u około 90% pacjentów, jednak poprawa funkcji wzrokowej zależy od wielu czynników prognostycznych. Kluczowe znaczenie ma stan plamki żółtej – pacjenci z odwarstwieniem bez zajęcia plamki (macula-on) mają znacznie lepsze rokowanie niż ci z zajęciem plamki (macula-off). Czas trwania odwarstwienia plamki jest istotnym czynnikiem, z negatywną korelacją między czasem trwania a pooperacyjną najlepszą skorygowaną ostrością wzroku (BCVA), gdzie leczenie w ciągu pierwszego tygodnia od wystąpienia objawów daje największe szanse na odzyskanie użytecznego widzenia. Przedoperacyjna BCVA oraz zakres odwarstwienia również korelują z wynikiem funkcjonalnym, a liczba prób chirurgicznych nie wpływa na ostateczną ostrość wzroku.

Prognoza odwarstwienia siatkówki (Retinal detachment Prognosis)

Czynniki wpływające na prognozę
Metody przewidywania wyniku wzrokowego
Zakres odwarstwienia siatkówki
Nawrót odwarstwienia
Znaczenie badań długoterminowych
Podsumowanie czynników prognostycznych
Kolejne rozdziały

Prognoza odwarstwienia siatkówki (Retinal detachment Prognosis)

Odwarstwienie siatkówki (OS) to proces, w którym neurosensoryczna warstwa oka, odpowiedzialna za odbieranie i przekazywanie sygnałów świetlnych do mózgu, oddziela się od leżącego pod nią nabłonka barwnikowego siatkówki. Nieleczone odwarstwienie siatkówki prowadzi do poważnej utraty wzroku. Prognoza wzrokowa po odwarstwieniu siatkówki zależy od wielu czynników, które zostaną omówione poniżej.¹

Czynniki wpływające na prognozę

Nowoczesne techniki leczenia pozwalają na pomyślne anatomiczne przyłożenie siatkówki u około 9 na 10 pacjentów z odwarstwieniem siatkówki. Jednak udane przyłożenie siatkówki nie zawsze oznacza satysfakcjonujący powrót widzenia. W większości przypadków do przyłożenia siatkówki wystarczają jedna lub dwie próby. Liczba prób nie wpływa na prawdopodobieństwo powrotu widzenia.²

Stan plamki żółtej

Kluczowym czynnikiem prognostycznym jest stan plamki żółtej. Pacjenci z odwarstwieniem siatkówki bez zajęcia plamki (macula-on) mają doskonałe rokowanie, podczas gdy pacjenci z zajęciem plamki (macula-off) mają gorszą ostrość wzroku po 10 latach obserwacji.³ Badania szkockie dotyczące odwarstwienia siatkówki wykazały, że długoterminowa najlepsza skorygowana ostrość wzroku (BCVA) pozostaje doskonała po skutecznym leczeniu odwarstwienia siatkówki bez zajęcia plamki, z prawie wszystkimi pacjentami osiągającymi standardy ostrości wzroku wymagane do prowadzenia pojazdów w Wielkiej Brytanii.⁴

Gdy plamka jest zajęta, odwarstwienie siatkówki poważnie zagraża przyszłemu widzeniu. Natomiast przy obwodowym odwarstwieniu leczenie zapobiegawcze, takie jak retinopeksja laserowa lub retinopeksja pneumatyczna, może pomóc uniknąć odwarstwienia plamki i zachować dobre widzenie centralne.⁵

Czas trwania odwarstwienia plamki

Czas, jaki upłynął od wystąpienia odwarstwienia, ma istotny wpływ na prognozę. Istnieje znacząca negatywna zależność między czasem trwania odwarstwienia plamki a ostrością wzroku po 10 latach.⁶ Gdy odwarstwienie plamki zostanie wykryte podczas pierwszej prezentacji i zdarzenie miało miejsce w ciągu ostatniego tygodnia, możliwe jest leczenie odwarstwienia z nadzieją na odzyskanie pewnego użytecznego widzenia. Normalne widzenie nie jest jednak osiągalne. Po tygodniu bardzo prawdopodobne jest, że jakiekolwiek odzyskane widzenie będzie ograniczone. U wielu pacjentów widzenie będzie tak słabe, że spadnie poniżej granicy prawnej ślepoty.⁷

Kilka badań wykazało, że przedoperacyjna ostrość wzroku, czas trwania odwarstwienia plamki i zakres odwarstwienia siatkówki są głównymi czynnikami związanymi z pooperacyjnym wynikiem wzrokowym. Dłuższy czas trwania odwarstwienia plamki i większy zakres odwarstwienia siatkówki były znacząco związane z gorszą pooperacyjną ostrością wzroku (odpowiednio r=0,55 i r=0,31).⁸

Czas trwania objawów

Czas trwania objawów (p = 0,031) wykazał statystycznie istotną negatywną korelację z pooperacyjną najlepszą skorygowaną ostrością wzroku (BCVA). Przedoperacyjna BCVA i czas trwania objawów mogą być wykorzystywane jako czynniki prognostyczne wyniku wzrokowego u pacjentów poddawanych witrektomii przez pars plana (PPV) z powodu rhegmatogennego odwarstwienia siatkówki (RRD).⁹

Badania wykazały, że podmioty z lepszą przedoperacyjną BCVA osiągnęły lepszy wynik funkcjonalny po PPV. Hierarchiczna analiza regresji podkreśliła, że wśród tych czynników prognostycznych przedoperacyjna BCVA miała najsilniejsze znaczenie statystyczne.¹⁰¹¹

Wczesna pooperacyjna ostrość wzroku

Najlepsza skorygowana ostrość wzroku (BCVA) pacjenta 1 tydzień po operacji rhegmatogennego odwarstwienia siatkówki (RRD) z zajęciem plamki najskuteczniej przewiduje ich ostateczne widzenie. Badacze odkryli, że BCVA 1 tydzień po PPV, integralność zewnętrznej błony granicznej (ELM), przedoperacyjne torbiele wewnątrzsiatkówkowe i czas trwania odwarstwienia plamki były związane z ostatecznym widzeniem. BCVA po 1 tygodniu była najsilniejszym predyktorem.¹²

Integralność strefy elipsoidalnej

Badania wskazują, że nieciągłość strefy elipsoidalnej (EZ) w obrazowaniu OCT (p = 0,024) wykazuje statystycznie istotną negatywną korelację z pooperacyjną BCVA.¹³ Integralność EZ wykazała statystycznie istotną korelację z pooperacyjną BCVA. Pooperacyjna nieciągłość EZ w obrazowaniu OCT plamki była jedyną pooperacyjną zmienną OCT związaną z gorszym pooperacyjnym wynikiem wzrokowym.¹⁴

Badanie PIONEER przeprowadzone na 15 pacjentach wykazało, że pooperacyjna ilościowa integralność EZ po 12 miesiącach jest bezpośrednio skorelowana z wynikami wzrokowymi.¹⁵

Falowanie warstwy zewnętrznej siatkówki

Falowanie warstwy zewnętrznej siatkówki (ORU) jest często obserwowane w przedoperacyjnym OCT w przypadku RRD. Podostry czas trwania objawów był znacząco związany z ORU w przedoperacyjnym OCT (p=0,001) i miał większą częstość występowania ORU (73,7%) niż ostre (OR=4,48) lub przewlekłe (OR=7,467) czasy trwania. ORU w przedoperacyjnym OCT sugeruje 10-30-dniowy czas trwania choroby w RRD.¹⁶

W badaniach wykazano, że obecność ORU w przedoperacyjnym OCT może być związana z czasem trwania odwarstwienia siatkówki. Integralność EZ jest użyteczna do przewidywania pooperacyjnej BCVA w odwarstwieniu siatkówki z zajęciem plamki, a przedoperacyjne obrazy OCT są przydatnym narzędziem do oceny czasu trwania i prognozy RRD.¹⁷

Metody przewidywania wyniku wzrokowego

Lotmar Visometer

Badania wykazały, że achromatyczny interferometr, Lotmar visometer, może być cenną metodą do oszacowania wyniku wzrokowego po niepowikłanej operacji zewnętrznej wgłobienia twardówki u pacjentów z odwarstwieniem siatkówki obejmującym plamkę.¹⁸ Według wyników badań pacjent z potencjalną ostrością 20/80 lub lepszą może osiągnąć pooperacyjną ostrość 20/50 lub lepszą, z prawdopodobieństwem 81%. Pomimo pewnych ograniczeń, pomiar potencjalnej ostrości przy użyciu Lotmar visometer może być użyteczną metodą w przewidywaniu wyniku wzrokowego w odwarstwieniu siatkówki z zajęciem plamki.¹⁹

Obrazowanie OCT

Optyczna koherentna tomografia (OCT) jest przydatna do oceny uszkodzenia siatkówki i prognozy wzrokowej u pacjentów z rhegmatogennym odwarstwieniem siatkówki. Przedoperacyjne obrazy OCT są cennym narzędziem do oceny czasu trwania i prognozy RRD.²⁰²¹

Zakres odwarstwienia siatkówki

Powrót ostrości wzroku zależy również od tego, czy odwarstwienie jest ograniczone zakresem, wówczas rokowanie jest doskonałe, pod warunkiem, że plamka jest oszczędzona.²² Generalnie, odwarstwienie siatkówki bez zajęcia plamki ma lepsze ostateczne rokowanie wzrokowe.²³

Nawrót odwarstwienia

Ponowne odwarstwienie jest rzadkie, ale wiąże się z gorszym wynikiem wzrokowym i w badanej kohorcie było częstsze u osób bez witrektomii.²⁴

Znaczenie badań długoterminowych

Szkockie badanie odwarstwienia siatkówki dostarczyło obiektywnych długoterminowych danych, które mogą kierować oczekiwaniami pacjentów i chirurgów po operacji odwarstwienia siatkówki.²⁵ Badania te wykazały, że pacjenci z odwarstwieniem siatkówki bez zajęcia plamki mają doskonałą prognozę, a niemal wszyscy pacjenci bez zajęcia plamki i większość pacjentów z zajęciem plamki osiągają brytyjski standard ostrości wzroku wymagany do prowadzenia pojazdów.²⁶

Pomimo wysokiego wskaźnika powodzenia anatomicznego u pacjentów poddawanych PPV z powodu pierwotnego RRD, wynik funkcjonalny jest wysoce zmienny.²⁷²⁸

Podsumowanie czynników prognostycznych

Podsumowując, głównymi czynnikami prognostycznymi wyniku wzrokowego po operacji odwarstwienia siatkówki są:

Stan plamki żółtej (zajęta vs. niezajęta)²⁹³⁰
Czas trwania odwarstwienia plamki³¹³²
Przedoperacyjna ostrość wzroku³³³⁴
Wczesna pooperacyjna ostrość wzroku (po 1 tygodniu)³⁵
Integralność strefy elipsoidalnej (EZ) w OCT³⁶³⁷
Zakres odwarstwienia siatkówki³⁸³⁹

Badania podkreślają, że szybka operacja jest szczególnie ważna dla pacjentów, którzy prawdopodobnie osiągną dobrą ostrość wzroku.⁴⁰

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Materiały źródłowe

#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
Retinal detachment refers to the process in which the neurosensory layer of the eye called the retina, which is responsible for receiving and transmitting light signals to the brain and enabling vision, is pulled off or peels off the underlying retinal pigment epithelium. If untreated, retinal detachment causes severe loss of vision. In some cases, it improves though it may take a few months for some degree of vision to return. […] The prognosis following a retinal detachment depends upon various factors, such as: The type of detachment, The time that has elapsed since it occurred. When macular detachment is detected at the time of first presentation and the event occurred within the last week, it is possible to treat the detachment and hope to regain some useful vision. Normal sight, however, is not attainable. After a week, it is very probable that whatever vision is regained will be limited. In many patients, vision will be so low as to fall below the limit for legal blindness.
#2 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
This also plays an important role in the prognosis. When the macula is affected, retinal detachment threatens the future vision severely. However, with peripheral detachment, preventive treatment such as laser retinopexy or pneumatic retinopexy may help avoid a macular detachment and conserve good central vision. […] Return of visual acuity depends also on whether the detachment is limited in extent, in which case the prognosis is excellent, provided the macula is spared. […] Modern treatment techniques have made for a good outcome in 9 out of every 10 patients with retinal detachment, as far as the reattachment is concerned. However, a successfully reattached retina does not always mean a satisfactory recovery of vision. In most cases, one or two attempts are sufficient to reattach the retina. In a few cases, more procedures may be required. The number of attempts does not influence the likelihood of sight recovery.
#3 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
Results demonstrate, as expected, that patients presenting with a macula-on retinal detachment have an excellent prognosis. Macula-off patients had a poorer 10-year BCVA, with a significant negative relationship between duration of macular detachment and BCVA at 10 years. […] Most patients are pseudophakic at follow-up, though a small number remain phakic. Redetachment is uncommon but confers a poorer visual outcome and in this cohort was more common in those without vitrectomy.
#4 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
To address the paucity of long-term data on outcomes following rhegmatogenous retinal detachment (RRD) repair we aimed to establish the 10-year best corrected visual acuity (BCVA), redetachment rate and lens status for patients from the Scottish Retinal Detachment Study. […] Long-term BCVA remains excellent following successful macula-on RRD repair with almost all macula-on, and most macula-off patients achieving the UK visual acuity driving standard. […] We demonstrate that macula-on detachments have significantly greater long long-term visual acuity than macula-off detachments, and that re-detachment is uncommon but confers a poorer long term visual outcome. […] This study provides objective long-term data to guide patient and surgeon expectations following retinal detachment repair.
#5 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
This also plays an important role in the prognosis. When the macula is affected, retinal detachment threatens the future vision severely. However, with peripheral detachment, preventive treatment such as laser retinopexy or pneumatic retinopexy may help avoid a macular detachment and conserve good central vision. […] Return of visual acuity depends also on whether the detachment is limited in extent, in which case the prognosis is excellent, provided the macula is spared. […] Modern treatment techniques have made for a good outcome in 9 out of every 10 patients with retinal detachment, as far as the reattachment is concerned. However, a successfully reattached retina does not always mean a satisfactory recovery of vision. In most cases, one or two attempts are sufficient to reattach the retina. In a few cases, more procedures may be required. The number of attempts does not influence the likelihood of sight recovery.
#6 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
Results demonstrate, as expected, that patients presenting with a macula-on retinal detachment have an excellent prognosis. Macula-off patients had a poorer 10-year BCVA, with a significant negative relationship between duration of macular detachment and BCVA at 10 years. […] Most patients are pseudophakic at follow-up, though a small number remain phakic. Redetachment is uncommon but confers a poorer visual outcome and in this cohort was more common in those without vitrectomy.
#7 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
Retinal detachment refers to the process in which the neurosensory layer of the eye called the retina, which is responsible for receiving and transmitting light signals to the brain and enabling vision, is pulled off or peels off the underlying retinal pigment epithelium. If untreated, retinal detachment causes severe loss of vision. In some cases, it improves though it may take a few months for some degree of vision to return. […] The prognosis following a retinal detachment depends upon various factors, such as: The type of detachment, The time that has elapsed since it occurred. When macular detachment is detected at the time of first presentation and the event occurred within the last week, it is possible to treat the detachment and hope to regain some useful vision. Normal sight, however, is not attainable. After a week, it is very probable that whatever vision is regained will be limited. In many patients, vision will be so low as to fall below the limit for legal blindness.
#8 Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer
https://pmc.ncbi.nlm.nih.gov/articles/PMC1771037/
Aim: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. […] The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula. […] Several studies have reported that preoperative visual acuity, duration of macular detachment, and extent of RD are the major factors related to postoperative visual outcome. […] Increased duration of macular detachment and extent of RD were significantly associated with less postoperative visual acuity (r=0.55 and r=0.31, respectively). […] According to our findings, a patient with potential acuity of 20/80 or better might reach a postoperative acuity of 20/50 or better, with a possibility of 81%. […] Although having some limitations, potential acuity measurement using the Lotmar visometer may be a useful method in predicting visual outcome in RD with macular involvement.
#9 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. […] Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
#10 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://www.mdpi.com/2077-0383/9/10/3251
Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment […] Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. […] Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome. […] Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Hierarchical regression analysis emphasized that among these prognostic factors, the preoperative BCVA had the strongest statistical significance. […] The integrity of the EZ showed statistically significant correlation with the postoperative BCVA. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#11 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Our hierarchical regression model showed that eyes with better preoperative BCVA achieved better functional outcome after PPV. […] In line with our findings, the PIONEER study conducted on 15 patients showed that postoperative quantitative integrity of EZ at 12 months is directly correlated with visual outcomes. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#12 Early Post-PPV Acuity Predicts Long-Term Visual Outcomes – Ophthalmology Advisor
https://www.ophthalmologyadvisor.com/news/early-acuity-predicts-long-term-visual-outcomes-after-retinal-detachment-repair/
Patients best-corrected visual acuity (BCVA) 1 week after macula-off rhegmatogenous retinal detachment (RRD) surgery most effectively predicts their final vision, according to research published in Retina. […] The investigators discovered that BCVA 1 week after PPV, ELM integrity, preoperative intraretinal cysts, and macula-off duration were linked with final vision. BCVA at 1 week was the strongest predictor. […] Our study emphasizes that timely surgery is particularly important for patients likely to achieve good VA, the researchers report.
#13 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. […] Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
#14 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://www.mdpi.com/2077-0383/9/10/3251
Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment […] Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. […] Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome. […] Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Hierarchical regression analysis emphasized that among these prognostic factors, the preoperative BCVA had the strongest statistical significance. […] The integrity of the EZ showed statistically significant correlation with the postoperative BCVA. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#15 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Our hierarchical regression model showed that eyes with better preoperative BCVA achieved better functional outcome after PPV. […] In line with our findings, the PIONEER study conducted on 15 patients showed that postoperative quantitative integrity of EZ at 12 months is directly correlated with visual outcomes. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#16 Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment | Scientific Reports
https://www.nature.com/articles/s41598-020-72907-6
Rhegmatogenous retinal detachment (RRD) is a vision-threatening pathology. Optical coherence tomography (OCT) is useful for evaluating retinal damage and visual prognosis in patients with RRD. Outer retinal undulation (ORU) is often observed on preoperative OCT in RRD. […] Subacute symptom duration was significantly associated with ORU on preoperative OCT (p=0.001) and had a higher prevalence of ORU (73.7%) than did acute (OR=4.48) or chronic (OR=7.467) durations. […] ORU on preoperative OCT suggests a 10-30 days morbidity duration in RRD. […] EZ integrity is useful for predicting postoperative BCVA in macula-off RRD. […] Many studies have reported that poorer visual outcomes are associated with a longer duration of preoperative retinal detachment. […] The current study found that the subacute group (10-30 days) had a higher incidence of ORU than did the other groups. Based on our results, ORU can be used to determine retinal detachment duration in patients with unknown duration of symptoms.
#17 Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment | Scientific Reports
https://www.nature.com/articles/s41598-020-72907-6
In the current study, ORU did not have a significant influence on visual outcome in patients with macula-off RRD. […] The main limitations of this study are as follows: the short follow-up duration of 6 months; the retrospective study design; […] In conclusion, the presence of ORU on preoperative OCT may be associated with the duration of retinal detachment. Integrity of the EZ is useful to predict postoperative BCVA in macula-off RRD, and preoperative OCT images are a useful tool for the assessment of the duration and prognosis of RRD.
#18 Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer | British Journal of Ophthalmology
https://bjo.bmj.com/content/86/3/278
Aim: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. […] The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.
#19 Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer
https://pmc.ncbi.nlm.nih.gov/articles/PMC1771037/
Aim: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. […] The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula. […] Several studies have reported that preoperative visual acuity, duration of macular detachment, and extent of RD are the major factors related to postoperative visual outcome. […] Increased duration of macular detachment and extent of RD were significantly associated with less postoperative visual acuity (r=0.55 and r=0.31, respectively). […] According to our findings, a patient with potential acuity of 20/80 or better might reach a postoperative acuity of 20/50 or better, with a possibility of 81%. […] Although having some limitations, potential acuity measurement using the Lotmar visometer may be a useful method in predicting visual outcome in RD with macular involvement.
#20 Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment | Scientific Reports
https://www.nature.com/articles/s41598-020-72907-6
Rhegmatogenous retinal detachment (RRD) is a vision-threatening pathology. Optical coherence tomography (OCT) is useful for evaluating retinal damage and visual prognosis in patients with RRD. Outer retinal undulation (ORU) is often observed on preoperative OCT in RRD. […] Subacute symptom duration was significantly associated with ORU on preoperative OCT (p=0.001) and had a higher prevalence of ORU (73.7%) than did acute (OR=4.48) or chronic (OR=7.467) durations. […] ORU on preoperative OCT suggests a 10-30 days morbidity duration in RRD. […] EZ integrity is useful for predicting postoperative BCVA in macula-off RRD. […] Many studies have reported that poorer visual outcomes are associated with a longer duration of preoperative retinal detachment. […] The current study found that the subacute group (10-30 days) had a higher incidence of ORU than did the other groups. Based on our results, ORU can be used to determine retinal detachment duration in patients with unknown duration of symptoms.
#21 Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment | Scientific Reports
https://www.nature.com/articles/s41598-020-72907-6
In the current study, ORU did not have a significant influence on visual outcome in patients with macula-off RRD. […] The main limitations of this study are as follows: the short follow-up duration of 6 months; the retrospective study design; […] In conclusion, the presence of ORU on preoperative OCT may be associated with the duration of retinal detachment. Integrity of the EZ is useful to predict postoperative BCVA in macula-off RRD, and preoperative OCT images are a useful tool for the assessment of the duration and prognosis of RRD.
#22 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
This also plays an important role in the prognosis. When the macula is affected, retinal detachment threatens the future vision severely. However, with peripheral detachment, preventive treatment such as laser retinopexy or pneumatic retinopexy may help avoid a macular detachment and conserve good central vision. […] Return of visual acuity depends also on whether the detachment is limited in extent, in which case the prognosis is excellent, provided the macula is spared. […] Modern treatment techniques have made for a good outcome in 9 out of every 10 patients with retinal detachment, as far as the reattachment is concerned. However, a successfully reattached retina does not always mean a satisfactory recovery of vision. In most cases, one or two attempts are sufficient to reattach the retina. In a few cases, more procedures may be required. The number of attempts does not influence the likelihood of sight recovery.
#23 Retinal Detachment: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/798501-overview
As the retina is neuro-sensitive tissue, visual prognosis can be difficult to predict. Generally, a retinal detachment without macular involvement tends to have a better final visual prognosis.
#24 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
Results demonstrate, as expected, that patients presenting with a macula-on retinal detachment have an excellent prognosis. Macula-off patients had a poorer 10-year BCVA, with a significant negative relationship between duration of macular detachment and BCVA at 10 years. […] Most patients are pseudophakic at follow-up, though a small number remain phakic. Redetachment is uncommon but confers a poorer visual outcome and in this cohort was more common in those without vitrectomy.
#25 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
To address the paucity of long-term data on outcomes following rhegmatogenous retinal detachment (RRD) repair we aimed to establish the 10-year best corrected visual acuity (BCVA), redetachment rate and lens status for patients from the Scottish Retinal Detachment Study. […] Long-term BCVA remains excellent following successful macula-on RRD repair with almost all macula-on, and most macula-off patients achieving the UK visual acuity driving standard. […] We demonstrate that macula-on detachments have significantly greater long long-term visual acuity than macula-off detachments, and that re-detachment is uncommon but confers a poorer long term visual outcome. […] This study provides objective long-term data to guide patient and surgeon expectations following retinal detachment repair.
#26 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
To address the paucity of long-term data on outcomes following rhegmatogenous retinal detachment (RRD) repair we aimed to establish the 10-year best corrected visual acuity (BCVA), redetachment rate and lens status for patients from the Scottish Retinal Detachment Study. […] Long-term BCVA remains excellent following successful macula-on RRD repair with almost all macula-on, and most macula-off patients achieving the UK visual acuity driving standard. […] We demonstrate that macula-on detachments have significantly greater long long-term visual acuity than macula-off detachments, and that re-detachment is uncommon but confers a poorer long term visual outcome. […] This study provides objective long-term data to guide patient and surgeon expectations following retinal detachment repair.
#27 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Our hierarchical regression model showed that eyes with better preoperative BCVA achieved better functional outcome after PPV. […] In line with our findings, the PIONEER study conducted on 15 patients showed that postoperative quantitative integrity of EZ at 12 months is directly correlated with visual outcomes. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#28 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://www.mdpi.com/2077-0383/9/10/3251
Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment […] Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. […] Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome. […] Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Hierarchical regression analysis emphasized that among these prognostic factors, the preoperative BCVA had the strongest statistical significance. […] The integrity of the EZ showed statistically significant correlation with the postoperative BCVA. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#29 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
Results demonstrate, as expected, that patients presenting with a macula-on retinal detachment have an excellent prognosis. Macula-off patients had a poorer 10-year BCVA, with a significant negative relationship between duration of macular detachment and BCVA at 10 years. […] Most patients are pseudophakic at follow-up, though a small number remain phakic. Redetachment is uncommon but confers a poorer visual outcome and in this cohort was more common in those without vitrectomy.
#30 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
This also plays an important role in the prognosis. When the macula is affected, retinal detachment threatens the future vision severely. However, with peripheral detachment, preventive treatment such as laser retinopexy or pneumatic retinopexy may help avoid a macular detachment and conserve good central vision. […] Return of visual acuity depends also on whether the detachment is limited in extent, in which case the prognosis is excellent, provided the macula is spared. […] Modern treatment techniques have made for a good outcome in 9 out of every 10 patients with retinal detachment, as far as the reattachment is concerned. However, a successfully reattached retina does not always mean a satisfactory recovery of vision. In most cases, one or two attempts are sufficient to reattach the retina. In a few cases, more procedures may be required. The number of attempts does not influence the likelihood of sight recovery.
#31 Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer
https://pmc.ncbi.nlm.nih.gov/articles/PMC1771037/
Aim: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. […] The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula. […] Several studies have reported that preoperative visual acuity, duration of macular detachment, and extent of RD are the major factors related to postoperative visual outcome. […] Increased duration of macular detachment and extent of RD were significantly associated with less postoperative visual acuity (r=0.55 and r=0.31, respectively). […] According to our findings, a patient with potential acuity of 20/80 or better might reach a postoperative acuity of 20/50 or better, with a possibility of 81%. […] Although having some limitations, potential acuity measurement using the Lotmar visometer may be a useful method in predicting visual outcome in RD with macular involvement.
#32 The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair | Eye
https://www.nature.com/articles/s41433-025-03613-8
Results demonstrate, as expected, that patients presenting with a macula-on retinal detachment have an excellent prognosis. Macula-off patients had a poorer 10-year BCVA, with a significant negative relationship between duration of macular detachment and BCVA at 10 years. […] Most patients are pseudophakic at follow-up, though a small number remain phakic. Redetachment is uncommon but confers a poorer visual outcome and in this cohort was more common in those without vitrectomy.
#33 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. […] Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
#34 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://www.mdpi.com/2077-0383/9/10/3251
Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment […] Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. […] Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome. […] Despite a high anatomic success rate in patients undergoing PPV for primary RRD, the functional outcome is highly variable. […] Our results suggest that the duration of symptoms, preoperative BCVA and the integrity of the EZ detected on OCT imaging are statistically significantly correlated to postoperative BCVA. […] Hierarchical regression analysis emphasized that among these prognostic factors, the preoperative BCVA had the strongest statistical significance. […] The integrity of the EZ showed statistically significant correlation with the postoperative BCVA. […] The results of our retrospective study indicate that preoperative BCVA and duration of symptoms to be statistically significant prognostic factors for the final visual outcome of patients undergoing vitrectomy for complex RRD. […] Postoperative discontinuity of EZ on OCT macular imaging was the only postoperative OCT variable related to a worse postoperative visual outcome.
#35 Early Post-PPV Acuity Predicts Long-Term Visual Outcomes – Ophthalmology Advisor
https://www.ophthalmologyadvisor.com/news/early-acuity-predicts-long-term-visual-outcomes-after-retinal-detachment-repair/
Patients best-corrected visual acuity (BCVA) 1 week after macula-off rhegmatogenous retinal detachment (RRD) surgery most effectively predicts their final vision, according to research published in Retina. […] The investigators discovered that BCVA 1 week after PPV, ELM integrity, preoperative intraretinal cysts, and macula-off duration were linked with final vision. BCVA at 1 week was the strongest predictor. […] Our study emphasizes that timely surgery is particularly important for patients likely to achieve good VA, the researchers report.
#36 Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment
https://pmc.ncbi.nlm.nih.gov/articles/PMC7601405/
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. […] A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. […] Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. […] Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
#37 Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment | Scientific Reports
https://www.nature.com/articles/s41598-020-72907-6
In the current study, ORU did not have a significant influence on visual outcome in patients with macula-off RRD. […] The main limitations of this study are as follows: the short follow-up duration of 6 months; the retrospective study design; […] In conclusion, the presence of ORU on preoperative OCT may be associated with the duration of retinal detachment. Integrity of the EZ is useful to predict postoperative BCVA in macula-off RRD, and preoperative OCT images are a useful tool for the assessment of the duration and prognosis of RRD.
#38 Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer
https://pmc.ncbi.nlm.nih.gov/articles/PMC1771037/
Aim: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. […] The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula. […] Several studies have reported that preoperative visual acuity, duration of macular detachment, and extent of RD are the major factors related to postoperative visual outcome. […] Increased duration of macular detachment and extent of RD were significantly associated with less postoperative visual acuity (r=0.55 and r=0.31, respectively). […] According to our findings, a patient with potential acuity of 20/80 or better might reach a postoperative acuity of 20/50 or better, with a possibility of 81%. […] Although having some limitations, potential acuity measurement using the Lotmar visometer may be a useful method in predicting visual outcome in RD with macular involvement.
#39 Azthena logo with the word Azthena
https://www.news-medical.net/health/Retinal-Detachment-Prognosis.aspx
This also plays an important role in the prognosis. When the macula is affected, retinal detachment threatens the future vision severely. However, with peripheral detachment, preventive treatment such as laser retinopexy or pneumatic retinopexy may help avoid a macular detachment and conserve good central vision. […] Return of visual acuity depends also on whether the detachment is limited in extent, in which case the prognosis is excellent, provided the macula is spared. […] Modern treatment techniques have made for a good outcome in 9 out of every 10 patients with retinal detachment, as far as the reattachment is concerned. However, a successfully reattached retina does not always mean a satisfactory recovery of vision. In most cases, one or two attempts are sufficient to reattach the retina. In a few cases, more procedures may be required. The number of attempts does not influence the likelihood of sight recovery.
#40 Early Post-PPV Acuity Predicts Long-Term Visual Outcomes – Ophthalmology Advisor
https://www.ophthalmologyadvisor.com/news/early-acuity-predicts-long-term-visual-outcomes-after-retinal-detachment-repair/
Patients best-corrected visual acuity (BCVA) 1 week after macula-off rhegmatogenous retinal detachment (RRD) surgery most effectively predicts their final vision, according to research published in Retina. […] The investigators discovered that BCVA 1 week after PPV, ELM integrity, preoperative intraretinal cysts, and macula-off duration were linked with final vision. BCVA at 1 week was the strongest predictor. […] Our study emphasizes that timely surgery is particularly important for patients likely to achieve good VA, the researchers report.