The increasing incidence of RRD and substantial populations in China present challenges to the routine inpatient surgical approach. Under this approach, patients experience extended waiting times of nearly two weeks or even one month before undergoing surgery. In response to the imperative to address patients' healthcare requirements, the Zhongshan Ophthalmic Center has built the first Department of Ophthalmic Emergency in China and instituted an "emergency green channel" specifically designed for cases of RRD[12].
In this study, clinical characteristics of RRD and the prevalence of RRDCD were compared between the emergency surgery group and the routine inpatient surgery group. The results demonstrated that patients had a shorter duration of RRD and a lower incidence of RRDCD in the emergency surgery group. Logistic regression analysis showed that a prolonged duration (> 7 days), pseudophakia/aphakia, multiple retinal tears, and a substantial extent of retinal detachment are independent risk factors for RRDCD. Therefore, our study indicates that the emergency surgical pattern may decrease the incidence of RRDCD by reducing the median time to surgery for RRD.
Consistent with prior research[3, 15, 16], our findings further support the idea of pseudophakia/aphakia status is a notable factor associated with RRDCD. Mahroo et al found that pseudophakic RRD patients were more likely to develop a total retinal detachment than phakic patients[17]. Mariantonia et al found that compared with phakic RRD, pseudophakic RRD had greater RD extent and PVR[13]. Based on the findings of the above study, pseudophakia/aphakia may be associated with RRDCD by exerting an influence on the vitreous and PVR[17, 18], subsequently impacting the extent of retinal detachment.
Most studies suggested that RRDCD was associated with multiple retinal tears[2, 15]. Yu et al found that total RRD might be the potential risk factor for the development of RRDCD in RRD patients[14]. A larger extent of retinal detachment may lead to significant breakdown of the blood-retinal barrier, exposing the retinal pigment epithelium. This exposure could potentially induce hypotony, along with the development of edema and detachment of the ciliary body and choroid20.
As the duration of RRD prolongs, persistent low intraocular pressure combined with severe immune reaction in the vitreous as the result of blood-retinal barrier breakdown could also induce the dilation and hyperpermeability of choroidal vessels, potentially leading to RRDCD. Therefore, for RRDCD, the duration of RRD might be an independent risk factor[19], which is consistent with our finding. In the studies of Yu et al[14] and Gu et al[15], no significant difference in the duration between RRDCD versus RRD was found. The durations explored in their studies extending beyond 14 days, while most patients with RRD had a duration ≤ 7 days (72.77%) in our emergency surgery group. Therefore, this disparity may obscure the potential impact of a shortened duration in reducing the incidence of RRDCD. Under our emergency surgical approach, patients with RRD can receive timely treatment, facilitated by the prompt availability of emergency triage services and efficient consultations with retinal surgeons.
Previous reports showed that macular hole and high myopia were the risk factors for RRDCD[14–16, 20, 21]. In our study, it appears that the contributions of macular hole and high myopia to predicting RRDCD are not statistically significant at the 0.05 level. Given that high myopia is frequently correlated with retinal degenerative changes, such as retinal breaks, necessitating retinal laser photocoagulation, our study excludes individuals who have undergone prior retinal laser treatment. This may explain the divergence in our results from previous study.
We acknowledge limitations in our study. We only recorded the number of retinal tears, without documenting the location/morphology of retinal breaks or the grades of PVR, thereby limiting the comparison between the RRDCD and RRD groups.
Our study revealed that patients with RRD experienced a shorter duration and a lower incidence of RRDCD under the emergency surgical pattern compared to the routine inpatient surgical pattern. Our findings confirmed that pseudophakia/aphakia, multiple retinal tears, total retinal detachment, and a prolonged duration may contribute to the development of RRDCD. The accessibility of the emergency surgical pattern significantly reduced median time to surgery for RRD, consequently lowering the incidence of RRDCD.