Comparative Analysis of Rhegmatogenous Retinal Detachment Repair with or without Associated Macular Hole

To assess the anatomic and functional outcomes in primary uncomplicated rhegmatogenous retinal detachment (RRD) compared to RRD associated with macular hole (MH).

This retrospective cohort study included 1303 eyes with RRD and 30 eyes with MH-RRD operated on between 2014 and 2018 at a single tertiary center. Main outcomes were single-surgery anatomic success (SSAS), MH closure and final pinhole visual acuity (PHVA).

Of the 1333 patients, 867 (65%) were male, and median [Q1, Q3] age was 63 [57, 70]. Most of these were macula-off detachments (n=764, 57%) with a higher proportion in MH-RRD (n=26, 87%) than primary RRD (n=738, 57%) (p=0.004). Baseline VA was lower in MH-RRD (p<0.001). Postoperative PHVA at three months was 0.30 [0.18, 0.54] in primary RRD vs. 0.85 [0.60, 1.30] in MH-RRD (p<0.001); final PHVA was 0.18 [0.10, 0.40] vs. 0.68 [0.40, 0.90] (p<0.001) respectively. Primary MH closure was achieved in 27 (90%) MH-RRD cases; at final follow-up, all 30 MH-RRDs had attached retinas with one persistent MH. MH presence was not significantly associated with SSAS (p=0.391), while increasing age was a negative predictor of SSAS (p=0.008). Male sex (p<0.001), SF6 tamponade (p<0.001), SSAS (p<0.001), and longer follow-up (p<0.001) were positive predictors of final PHVA.

SSAS did not significantly differ between the two groups though the small MH-RRD sample may have contributed to this. Functional outcomes were poorer in MH-RRD, likely due to more macula-off RRD, more retinal breaks, occasional MH closure failure and residual sequelae related to the MH.