For patients with rhegmatogenous retinal detachment (RRD), the clock starts ticking from the first symptoms. Although pars plana vitrectomy (PPV) has transformed anatomical outcomes, predicting how much vision a patient will regain remains a clinical challenge. A new retrospective study from the Emergency County Hospital of Cluj-Napoca, Romania, offers further evidence that functional recovery depends less on a single headline feature and more on a combination of temporal and structural factors.
The Diagnostics study reviewed 136 eyes from 135 patients who underwent PPV for primary RRD between January 2021 and December 2024. All surgeries were performed by a single experienced retinal surgeon, reducing inter-surgeon variability. Patients with previous retinal detachment, traumatic detachment, tractional or exudative detachment, and other ocular or retinal comorbidities were excluded.
The cohort reflected a typical RRD population: mean age was 64.6 years, 73.5 percent of eyes were phakic at presentation, and the macula was detached in 81.6 percent. Symptom duration varied widely, from two to 94 days, with a mean of 12.9 days. Preoperative best corrected visual acuity (BCVA) averaged 1.52 logMAR, improving to 0.74 logMAR at six months. Primary anatomical success was achieved in 123 patients, while 13 required additional surgery for redetachment; all ultimately achieved retinal reattachment by six months.
The study authors found three factors that were significantly associated with postoperative BCVA: duration of symptoms, baseline BCVA, and phacoemulsification during follow-up. Each additional day between symptom onset and surgery was associated with a 0.007-unit increase in six-month logMAR BCVA, indicating poorer visual recovery with delay. Preoperative BCVA also remained a strong predictor: worse vision at presentation translated into worse functional outcome at six months.
Interestingly, several factors often assumed to drive prognosis did not remain independently significant in the final model. Lens status, macular status, extent of detachment, number of retinal tears, lattice degeneration, and proliferative vitreoretinopathy were not independently associated with six-month BCVA after adjustment.
The macular finding deserves particular caution. Patients with macula-on detachments had substantially better vision at presentation and maintained better vision throughout follow-up. However, macular status did not remain significant in the multivariate analysis. The authors suggest this may reflect limitations of retrospective clinical classification, particularly in the absence of routine preoperative optical coherence tomography. Some macula-on cases may have had subtle foveal involvement, while very recent macula-off detachments may not yet have incurred severe functional damage.
The study also observed a trend toward better outcomes in patients with hypertension, although this did not remain statistically significant in the final model. The authors speculate that antihypertensive treatment, particularly ACE inhibitors, may have a retinal protective effect through modulation of the renin–angiotensin system, but emphasize that this requires further study that considers the medication patients were using before symptoms occurred.
For clinicians counseling RRD patients before surgery, the study reinforces a pragmatic point: prognosis should not be reduced to macular status alone. Instead, the best predictions may come from integrating symptom duration, baseline BCVA, and the broader clinical picture.
