The management of primary rhegmatogenous retinal detachment not involving the fovea.

Aim: To establish the likelihood of, and risk factors associated with, progression of 'macula-on' retinal detachment.

Methods: A multi-centre prospective observational study of patients with acute retinal detachment, not involving the fovea, was conducted over a 6-month period. Data collected included duration of symptoms, visual acuity, presence of posterior vitreous detachment, retinal drawings and subretinal fluid (SRF) distance from the fovea at a minimum of two time points.

Results: A total of 82 data sets from 15 institutions were analysed. Of 82 cases 11 (13%) demonstrated progression of fluid. Mean progression in those cases which progressed was 2.3 disc diameters (dd) and the average rate of progression was 1.80 dd/day. Binary regression analysis failed to reveal any statistically significant risk factors for progression. Multiple regression analyses were made to identify risk factors. With distance of SRF from fovea at operation as a function, distance of SRF at presentation was the only statistically significant risk factor. In all, 26% of patients underwent surgery out-of-hours. A total of 83% patients achieved a 6-week best-corrected vision of 6/9 or better.

Conclusion: Most retinal detachments in this study did not progress within the first few days. The distance of SRF from the fovea at presentation was the only statistically significant risk factor for progression to foveal detachment.