- Title: Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment

- Purpose: To investigate the impact of surgical timing on visual acuity (VA) outcomes in retinal detachments (RDs) based on preoperative foveal status (fovea-on, fovea-split, or fovea-off).

- Methods:

  - Study Design: Retrospective multicenter cohort study using data from the Primary Retinal Detachment Outcomes (PRO) study database.

  - Participants: 1,675 cases of primary RD repair stratified into fovea-on (709 cases), fovea-split (151 cases), and fovea-off (815 cases) groups.

  - Outcome Measures: Final postoperative VA was measured, and the impact of surgical timing (days to surgery) was analyzed.

- Results:

  - Fovea-On and Fovea-Split Groups:

    - No significant difference in final VA outcomes between fovea-on (20/33) and fovea-split (20/32) groups.

    - Timing of surgery (within 1 day vs. delayed) did not significantly affect VA outcomes in these groups.

  - Fovea-Off Group:

    - Final VA was significantly worse (20/56) compared to fovea-on and fovea-split groups.

    - Delayed surgery (≥2 days) resulted in worse VA outcomes (20/74) compared to surgery within 1 day (20/46).

  - Surgical Timing:

    - Over 80% of fovea-on and fovea-split cases had surgery within 1 day.

    - Only 56.4% of fovea-off cases had surgery within 1 day.

  - Anatomic Success: Single surgery success rate was >85% for all groups.

- Discussion:

  - Fovea-On RDs: Emergent surgery may not be necessary, as delays up to 3 days did not significantly affect VA outcomes.

  - Fovea-Split RDs: Similar to fovea-on RDs, these cases had favorable VA outcomes regardless of surgical timing.

  - Fovea-Off RDs: Earlier surgery (within 1-2 days) is associated with better VA outcomes, as delays lead to worse visual prognosis.

  - Limitations: Retrospective design, lack of standardized preoperative symptom data, and limited external validity due to high-volume centers.

- Conclusion:

  - Fovea-on and fovea-split RDs have comparable VA outcomes, and delays in surgery do not significantly affect visual results.

  - Fovea-off RDs have worse VA outcomes, especially when surgery is delayed by 2 or more days.

  - Surgeons should prioritize earlier surgery for fovea-off RDs to optimize visual outcomes.