Success rates of retinal detachment surgery: routine versus emergency setting

Surgery for rhegmatogenous retinal detachment (RRD) should usually be performed as soon as possible. However, a risk of operating in an emergency setting has to be considered against the risk of delaying it.

In a retrospective, interventional, non-comparative clinical case series we reviewed the charts of all patients who underwent surgery for primary noncomplex RRD between February 1999 and July 2009. The primary anatomical success (PAS) of RRD surgery was the primary outcome measure, which was defined as permanent reattachment of the retina after a single surgical procedure. All cases were classified as (I) surgical cases, which were performed as emergency procedures the night of the patient's admission to the hospital (emergency setting), and as (II) those cases, which were operated in a routine setting during daytime (routine setting). Visual acuity was documented 2 and 6 months after surgery

1810 cases of primary noncomplex RRD were analysed. PAS rates were 88.0 % in the routine setting and 87.3 % in the emergency setting (p = 0.67). While expert surgeons' PAS rates did not differ between routine and emergency, non-experts achieved inferior anatomical results, when performing surgery in the emergency setting (81.6 % vs. 88.3 %; p = 0.02). There was no difference between expert (87.7 %) and non-expert surgeons (88.6 %) in the routine setting (p = 0.75). There was no statistically significant difference in visual acuity.

Prompt RRD surgery in an emergency setting did not improve the anatomical outcome and was worse if performed by non-expert surgeons. The possibility to schedule surgery may improve delivery of care without compromising the outcome. Although we did not see a significant functional difference, there was a trend for better visual acuity for experts and routine setting. If one decides that prompt surgery is necessary, it should only be done by an experienced vitreoretinal surgeon.