Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Rethinking the urgency priority system in round hole detachments, which should be done first? Macula on or macula off.

Eye (2024)Cite this article

Subjects

It has been well established that round hole detachments are a different type of retinal detachment than the those which occur due to a horseshoe tear following posterior vitreous detachment (complete or incomplete) [1]. In the large majority of these patients the findings are (1) incidental and (2) enjoy an extra ordinarily high success rate of around 99% [2].

The presence of a tide mark suggests chronicity and often these patients have a very slowly progressing pathology, if at all [1]. There are two reasons for this, firstly there is no traction on a round hole unlike a horseshoe tear such that the fluid currents that are formed from ocular saccades can only displace or encourage limited fluid into that space, secondly the vitreous itself due to the absence of a PVD in the majority of cases acts as a endotamponade while the retinal pigment epithelial pump absorbs the residual fluid. In the latter, multiple tide mark areas may be present. Despite this, round hole detachments can progress and require treatment, preferably by cryobuckle. The argument or practise point that merits consideration is; which cases to prioritise in a limited resource environment or priority system.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Demonstrating a single round hole as an incidental finding referral to our clinic.

References

  1. Byer NE. The natural history asymptomatic retinal breaks. Opthamolgy. 1982;89:1033–9.

    CAS  Google Scholar 

  2. Ung T, Comer MB, Ang AJ, Sheard R, Lee C, Poulson AV, et al. Clinical features and surgical management of retinal detachment secondary to round retinal holes. Eye. 2005;19:665–9.

    Article  CAS  PubMed  Google Scholar 

  3. Sultan ZN, Agorogiannis EI, Iannetta D, Steel D, Sandinha T. Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management. BMJ Open Ophthalmol. 2020;5:e000474.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Williamson T, Shunmugam M, Rodrigues I, Dogramci M, Lee E. Characteristics of rhegmatogenous retinal detachment and their relationship to visual outcome. Eye. 2013;27:1063–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Grabowska A, Neffendorf JE, Yorston D, Williamson T. Urgency of retinal detachment repair: is it time to re-think our priorities? Eye. 2021;35:1035–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK

    A. Javed, M. O. Qadir, S. Lee, A. Mitra, A. Tyagi, A. Sharma, K. Lett & S. Ch’ng

Authors
  1. A. Javed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. O. Qadir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Mitra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Tyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Lett
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Ch’ng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AJ thought of the study and compiled the manuscript, MOQ and SL contributed to editing the manuscript. AM, AT, AS, KL and SC reviewed the final manuscript, discussed and fed back to AJ to make changes and contributed their personal experiences and ideas to the final manuscript.

Corresponding author

Correspondence to A. Javed.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Javed, A., Qadir, M.O., Lee, S. et al. Rethinking the urgency priority system in round hole detachments, which should be done first? Macula on or macula off.. Eye (2024). https://doi.org/10.1038/s41433-024-02930-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41433-024-02930-8

Search

Advanced search

Quick links