The timing of rhegmatogenous retinal detachment (RRD) surgery, especially macula-involving cases, in the UK is controversial. Urgency of operation is traditionally dependent on macular attachment. Macula sparing RRD is often regarded as more urgent and operated on within 24 h, whilst macula involving RRD generally scheduled for surgery within 1 week or longer [1].
With increasing evidence [2, 3] regarding the importance of surgical timing and an improved understanding of the effect of macular off duration on outcome, a regional weekend vitreoretinal (VR) service was set up between two neighbouring VR units covering a total population of over 2 million.
We retrospectively reviewed all patients with acute RRD that were operated over the weekend between January 2018 and December 2019 as part of regional VR on-call service covering two units (Newcastle Eye Centre and Sunderland Eye Infirmary) in Northern England. The on-call was designed to treat acute progressive foveal sparing RRD that would likely progress to the fovea over the weekend [4], and recent fovea-involving RRD. For this analysis, eyes with previous RRD surgery were excluded. Baseline characteristics including macula status, best corrected visual acuity (BCVA) at baseline and final follow-up, anatomical outcome and operative complications were recorded. The regression formula derived from Yorston et al. [5] was used to calculate a predicted visual acuity outcome for the macular involving cases based on their weekend date of surgery. This was compared to the predicted outcome if their surgery had taken place on Monday, and the actual visual outcome observed.
90 eyes (90 patients) were included, equating to an average of approximately one eligible case per weekend. 26 (28.9%) were female with median age of 60 (Interquartile range (IQR) 13). Median follow-up duration was 6 months with a minimum of 2 months. 35 eyes (38.9%) were macula involving and 61 (67.8%) phakic. The majority (97.8%) underwent vitrectomy, one was treated with scleral buckling and one with pneumatic retinopexy. Overall, 83 eyes (92.2%) achieved primary anatomical success. Subgroup analysis is shown in Table 1.
There were no intraoperative complications. 44 eyes (72% of phakic eyes) developed visually significant cataract requiring surgery.
Using the probability calculator [5] as shown in Table 2, 74.4% of the macula involving eyes overall were predicted to achieve a post-operative BCVA of 0.3 logMAR (6/12) or better based on their actual timing of surgery; this was significantly different from the 66.7% predicted if they had been operated upon on the following Monday (p < 0.001). In reality 24 of our 31 eyes with primary attachment (77.4%) achieved 0.3 logMAR or better, reflecting the predicted weekend results closely (χ2 = 0.088, p = 0.767). Although our study is limited with a relatively small sample size, our findings suggest that this regional weekend service improved the probability of our macula involving RRD patients in achieving driving vision or better.
In summary, the service was safe and effective, with favourable RRD surgical outcomes. The results suggest a higher probability of visual recovery due to earlier surgical intervention. We demonstrate a potential collaborative model that could be implemented between adjacent units to improve outcomes.
Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
van Bussel EM, van der Valk R, Bijlsma WR, La, Heij EC. Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature. Retina. 2014;34:1917–25.
Grabowska A, Neffendorf JE, Yorston D, Williamson TH. Urgency of retinal detachment repair: is it time to re-think our priorities? Eye. 2021;35:1035–6.
Williamson TH, Lee EJ, Shunmugam M. Characteristics of rhegmatogenous retinal detachment and their relationship to success rates of surgery. Retina. 2014;34:1421–7.
Kontos A, Williamson TH. Rate and risk factors for the conversion of fovea-on to fovea-off rhegmatogenous retinal detachment while awaiting surgery. Br J Ophthalmol. 2017;101:1011–5.
Yorston D, Donachie PHJ, Laidlaw DA, Steel DH, Sparrow JM, Aylward GW, et al. Factors affecting visual recovery after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study. Eye. 2021;35:1431–9.
Author information
Authors and Affiliations
Consortia
Contributions
BLT collected, analysed, interpreted data and write up the manuscript. MAZ collected, analysed, interpreted data and revised manuscript. RJH and DHS analysed, interpreted data and revised manuscript critically with approval of the final version. VR Study Group revised manuscript with approval of the final version.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Teh, B.L., Al-Zubaidy, M., Hillier, R.J. et al. Outcomes of weekend surgery for acute retinal detachment. Eye 37, 1942–1943 (2023). https://doi.org/10.1038/s41433-022-02256-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41433-022-02256-3