New insights into an old problem: Rethinking the risk factor of rhegmatogenous retinal detachment associated with choroidal detachment from the viewpoint of treatment patterns: A retrospective study

New insights into an old problem: Rethinking the risk factor of rhegmatogenous retinal detachment associated with choroidal detachment from the viewpoint of treatment patterns: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article New insights into an old problem: Rethinking the risk factor of rhegmatogenous retinal detachment associated with choroidal detachment from the viewpoint of treatment patterns: A retrospective study Tao Li, Kunbei Lai, Kai Gao, ziye chen, Zhuangling Lin, Wenbin Zheng, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3988319/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To compare the proportion of rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD. Methods: A total of 694 patients (eyes) diagnosed with rhegmatogenous retinal detachment (RRD) in the emergency surgery group were included from the Department of Ophthalmic Emergency, and 692 patients (eyes) in the routine inpatient surgery group were selected randomly from the Ocular Fundus Department. Demographics, refractive status, macular status, lens status, extent of retinal detachment, number of retinal breaks, duration of symptoms before surgery, and the incidence of RRDCD were compared. A logistic regression analysis was used to determine potential risk factors for RRDCD. Results: Compared to the routine inpatient surgery group, the emergency surgery group had a significant less median time to surgery ( P < 0.001) and a decreased proportion of RRDCD (2.88% vs. 10.84%, P < 0.001). Logistic regression analysis revealed that a prolonged duration of RRD [OR 3.51, 95% CI (1.98-6.23)], pseudophakia/aphakia status [OR 2.74, 95% CI (1.50-4.98)], multiple retinal breaks [OR 1.67, 95% CI (1.03-2.70)], and a substantial extent of RRD [OR 11.58, 95% CI (7.12-18.84)] were independent risk factors for RRDCD. Conclusions: Emergency surgical pattern of RRD demonstrated a lower incidence of RRDCD. The adoption of an expedited surgical approach has the potential to reduce the duration of RRD, possibly correlating with a decreased risk of RRDCD development. Health sciences/Risk factors Health sciences/Diseases/Eye diseases/Retinal diseases rhegmatogenous retinal detachment with choroidal detachment ophthalmic emergency rhegmatogenous retinal detachment. Figures Figure 1 Figure 2 Figure 3 Background Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is a complicated form of rhegmatogenous retinal detachment (RRD) with poor prognosis[ 1 , 2 ]. Although the pathogenesis of RRDCD is unclear, most related studies suggest that inflammatory responses and low intraocular pressure (IOP) after RRD stimulates the expansion and hyperpermeability of choroidal vessel, which contributes to RRDCD[ 2 – 4 ]. The prevalence of RRDCD among RRD varies from 2–18.79% in different studies[ 2 , 5 – 7 ]. Due to the high incidence of proliferative vitreoretinopathy (PVR) after surgery, the primary anatomic reattachment rate was reported to be less than 70% in RRDCD[ 2 , 8 ]. As the techniques of vitrectomy advanced and preoperative management (e.g., preoperative administration of steroids) improved, the anatomic success rate of RRDCD has increased to 81.8%[ 5 , 8 – 10 ]. However, RRDCD remains a remarkable risk factor for primary surgical failures and poor prognosis of RRD[ 11 ]. Identifying the risk factor of RRDCD is of great significance for early intervention. Our earlier study demonstrated that implementation of the emergency surgical protocol for RRD clearly reduced the treatment interval of RRD, resulting in improved prognoses for affected patients [12] . However, it is still unclear whether the incidence of RRDCD changes after prompt emergency surgical intervention based on existing literature. This study aims to determine whether the implementation of the emergency surgical pattern contributes to a decreased incidence of RRDCD and to identify potential risk factors associated with occurrence of RRDCD. Methods Study design The medical records of patients who underwent RRD surgery at the Zhongshan Ophthalmic Centre (ZOC) were reviewed retrospectively, and patients complicated with RRDCD were identified. The Institutional Review Board of ZOC granted a waiver of informed consent for this research due to its retrospective nature. Patients with RRD who underwent routine inpatient surgery between October 2019 and December 2020 were enrolled as the routine inpatient surgery group (Fig. 1 ). We implemented an emergency protocol for RRD from January 2021 to provide urgent care for RRD patients. Those individuals who fulfilled the criteria for the emergency surgical protocol and underwent emergency surgery between January 2021 and March 2022 were categorized into the emergency surgery group (Fig. 2 ). The indications for emergency surgery in cases of RRD are as follows: 1) RRD with macular-on; 2) RRD with macular-off lasting less than 3 days. Macular status was verified by slit lamp examination, fundus color photography, and optical coherence tomography. RRDCD was diagnosed by ultrasound B-scan, ultrasound biomicroscope (UBM), slit lamp examination, or intraoperative findings. The number of retinal breaks and extent of RRD were verified by slit lamp examination, color fundus photography, or intraoperative condition. Demographics, refractive status (high myopia was defined as a spherical equivalent refraction of − 6.0 D or less), macular status, lens status, extent of RRD, number of retinal breaks, duration of RRD, and the incidence rate of RRDCD were recorded and compared. As total retinal detachment has been reported to be a risk factor for RRDCD[ 13 , 14 ], patients were stratified into two groups based on the extent of retinal detachment: those with a retinal detachment extent less than or equal to 3 quadrants and those with a retinal detachment extent equal to 4 quadrants. Inclusion/Exclusion Criteria The inclusion criteria were as follows: (1) all participants aged from 18 to 85 years; (2) a diagnosis of RRD was established based on slit lamp examination with a 90-diopter lens, ultrasound B-scan or color fundus photography; and (3) we investigated whether choroidal detachment occurred with RRD by clinical examinations or intraoperative findings. Exclusion criteria included: (1) a diagnosis of exudative RRD or tractional RRD; (2) history of age-related macular degeneration, diabetic retinopathy, retinal artery or vein occlusion; and (3) history of intravitreal injection, retinal photocoagulation or other intraocular treatment (except for uneventful cataract surgery). Statistical analysis IBM SPSS 20.0 software (SPSS Inc, Chicago, IL, USA) was employed for statistical analysis. Quantitative data were expressed as mean ± standard deviation or median (interquartile range, IQR), and analyzed by t test or Mann-Whitney U test. Categorical data were expressed as frequency and analyzed by chi-squared test. The independent risk factors for RRDCD were analyzed by binary logistic regression analysis. P < 0.05 was regarded as statistical significance. Results The Emergency Surgery Group vs. The Routine Inpatient Surgery Group Based on the eligibility criteria, 694 eyes from 694 patients underwent emergency surgery, while 692 eyes from 692 patients received routine inpatient surgery. Compared to the routine inpatient surgery group, patients in the emergency surgery group had a lower proportion of RRDCD (2.88% vs. 10.84%) (P < 0.001). In the emergency surgery group, the median (IQR) duration of RRD was 5 (3–10) days and 72.77% of patients experienced vision loss for less than or equal to 7 days. However, in the routine inpatient surgery group, the median (IQR) duration of RRD was 15 (10–30) days and only 17.92% of patients experienced vision loss for less than or equal to 7 days, as shown in Table 1 . There was no significant difference in age (46.74 ± 13.21 years vs. 47.22 ± 14.70 years), gender (male accounted for 68.15% vs. 66.91%), the status of refraction (high myopia accounted for 24.50% vs. 21.39%), the status of the macula (macular hole accounted for 2.88% vs. 2.31%), lens status (phakia accounted for 90.63% vs. 90.03%), number of retinal tears (> 1 accounted for 28.53% vs. 29.48%) and extent of RRD (4 quadrants accounted for 7.64% vs. 10.40%) between the two groups ( P > 0.05). Table 1 Clinical and demographics of the emergency surgery group and the routine inpatient surgery group. Characteristics Emergency surgery group Mean ± Standard Deviation or No. (%) Inpatient surgery group Mean ± Standard Deviation or No. (%) P value Patients / No. of eyes 694/694 692/692 - Age, years † 46.74 ± 13.21 47.22 ± 14.70 0.313 Gender ‡ 0.646 Male 473 (68.15) 463(66.91) Female 221(31.85) 229(33.09) Affected eye ‡ 0.385 Right eye 390(56.20) 405(58.53) Left eye 304(43.80) 287(41.47) High myopia ‡ 170(24.50) 148(21.39) 0.180 Macular hole ‡ 20 (2.88) 16 (2.31) 0.613 Lens status ‡ 0.717 Phakic 629(90.63) 623(90.03) Pseudophakic/Aphakic 65(9.37) 69(9.97) No. of retinal tears ‡ 0.723 1 496(71.47) 488(70.52) > 1 198(28.53) 204(29.48) Extent of retinal detachment ‡ 0.0753 ≤ 3 quadrants 641(92.36) 620(89.60) 4 quadrants 53(7.64) 72(10.40) Duration of RRD ‡ ≤ 7 days 505(72.77) 124(17.92) 7 days 189(27.23) 568(82.08) with choroidal detachment ‡ 20(2.88) 75(10.84) <0.001* RRD = rhegmatogenous retinal detachment †by Mann-Whitney U test; ‡by chi-squared test; * Indicates P <0.001. RRD Group vs. RRDCD Group A total of 1386 RRD patients (1386 eyes) in both emergency and routine inpatient surgery group were studied, 95 patients (95 eyes) diagnosed with RRDCD in RRDCD group and 1291 patients (1291 eyes) without choroidal detachment in RRD group. Clinical and demographics data of RRD group and RRDCD group were presented in Table 2 . The RRDCD group had more patients with pseudophakic/aphakic eyes, multiple retinal tears, total retinal detachment, and longer duration than RRD Group ( P 1), extent of retinal detachment (≤ 3 quadrants vs. 4 quadrants), and duration of RRD (≤ 7 days vs. >7 days). Binary Logistic regression analysis revealed that pseudophakia/aphakia [OR 2.74, 95% CI (1.50–4.98)], multiple retinal tears [OR 1.67, 95% CI (1.03–2.70)], total retinal detachment [OR 11.58, 95% CI (7.12–18.84)], and a prolonged duration (> 7 days) [OR 3.51, 95% CI (1.98–6.23)] were identified as independent risk factors for RRDCD (All P < 0.05), as shown in Fig. 3 . Table 2 Clinical and demographics of the RRD eyes with and without choroidal detachment Characteristics RRD without CD Mean ± Standard Deviation or No. (%) RRD with CD Mean ± Standard Deviation or No. (%) P value Patients / No. of eyes 1291/1291 95/95 - Age, years † 46.86 ± 13.93 48.57 ± 14.52 0.196 Gender ‡ 0.140 Male 865 (67.00) 71 (74.74) Female 426 (33.00) 24 (25.26) Affected eye ‡ 0.830 Right eye 739 (57.24) 56 (58.95) Left eye 552(42.76) 39 (41.05) High myopia ‡ 299(23.16) 19 (20.00) 0.529 Macular hole ‡ 32(2.48) 4(4.21) 0.305 Lens status ‡ 1 362 (28.04) 40 (42.11) Extent of retinal detachment ‡ < 0.001** ≤ 3 quadrants 1212 (93.88) 49 (51.58) 4 quadrants 79 (6.12) 46 (48.42) Duration of RRD ‡ ≤ 7 days 612 (47.41) 17 (17.89) 7 days 679 (52.59) 78 (82.11) RRD = rhegmatogenous retinal detachment; CD = choroidal detachment. †by Mann-Whitney U test; ‡by chi-squared test; * Indicates P <0.05; ** Indicates P <0.001. Discussion 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 choroid 20 . 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. Declarations Acknowledgements Not applicable. Conflicts of Interest statement No conflicting interest exists for any author. Funding This study was granted from the Medical Scientific Research Foundation of Guangdong Province, China [C2022060] and the Natural Science Foundation of Guangdong Province, China [2020A1515111108]. The funders had no role in the design and conduct of this work, preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication. Availability of data and materials Available from the corresponding author on reasonable request. Ethics approval and consent to participate This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethical Review Committee of Zhongshan Ophthalmic Centre (Ethics Approval Number: 2022KYPJ054). Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests References Wu Z, Ding N, Yu M, Wang K, Luo S, Zou W et al. Identification of Potential Biomarkers for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment by Vitreous iTRAQ-Based Proteomic Profiling. Int J Mol Sci. 2016; 17(12). Li Z, Li Y, Huang X, Cai XY, Chen X, Li S et al. Quantitative analysis of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese using UBM. Retina (Philadelphia, Pa). 2012; 32(10):2020-2025. Seelenfreund MH, Kraushar MF, Schepens CL, Freilich DB. Choroidal detachment associated with primary retinal detachment. 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Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res. 2014; 51(1):15-31. Li J, Zhao M, She H, Chandra A. The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services-Experiences from the Tongren eye center in Beijing. PloS one. 2021; 16(8):e0254751. Kang JH, Park KA, Shin WJ, Kang SW. Macular hole as a risk factor of choroidal detachment in rhegmatogenous retinal detachment. Korean J Ophthalmol. 2008; 22(2):100-103. O'Brien K. The effect of the male-female body-size difference on absorbed dose-rate distributions in humans from natural gamma rays. Health Phys. 1978; 34(1):107-112. Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Science","correspondingAuthor":false,"prefix":"","firstName":"Chinling","middleName":"","lastName":"Tsai","suffix":""},{"id":292393436,"identity":"098c2fc8-57ad-4c53-904f-20a1b54026db","order_by":13,"name":"Zhuojun Xu","email":"","orcid":"","institution":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science","correspondingAuthor":false,"prefix":"","firstName":"Zhuojun","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-02-25 15:20:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3988319/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3988319/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57509277,"identity":"07922a48-a8ff-459e-8e21-b57614e94197","added_by":"auto","created_at":"2024-05-31 16:14:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":201982,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart showing the process for determining eligibility for inclusion in the inpatient surgery group between October 2019 and December 2020.\u003c/p\u003e","description":"","filename":"FIGURE1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3988319/v1/725e2703f073819a42e60e4d.jpg"},{"id":57509279,"identity":"fc52950e-6016-4127-a729-c0bb9050f0e8","added_by":"auto","created_at":"2024-05-31 16:14:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":274330,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart showing the process for determining eligibility for inclusion in the emergency surgery group between January 2021 and March 2022.\u003c/p\u003e","description":"","filename":"FIGURE2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3988319/v1/893f48a755e2e8cee9de1b25.jpg"},{"id":57509280,"identity":"07251879-cee5-419f-9d73-107f10710f3d","added_by":"auto","created_at":"2024-05-31 16:14:54","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":156536,"visible":true,"origin":"","legend":"\u003cp\u003eBinary Logistic regression analysis showed that pseudophakia/aphakia, multiple retinal tears, total retinal detachment, longer duration (\u0026gt;7 days) are independent risk factors of RRDCD (OR values greater than 1 indicating positive relationship and OR values less than 1 indicating negative relationship; * indicates \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01, ** indicates \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"FIGURE3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3988319/v1/c925b2aa48922a85aebd479e.jpg"},{"id":58134168,"identity":"8e970c7f-e719-41ec-bf57-be805ff30130","added_by":"auto","created_at":"2024-06-11 15:13:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1262016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3988319/v1/7aed4b7c-61e6-4164-84e9-ae17178cb15e.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"New insights into an old problem: Rethinking the risk factor of rhegmatogenous retinal detachment associated with choroidal detachment from the viewpoint of treatment patterns: A retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eRhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is a complicated form of rhegmatogenous retinal detachment (RRD) with poor prognosis[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although the pathogenesis of RRDCD is unclear, most related studies suggest that inflammatory responses and low intraocular pressure (IOP) after RRD stimulates the expansion and hyperpermeability of choroidal vessel, which contributes to RRDCD[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of RRDCD among RRD varies from 2\u0026ndash;18.79% in different studies[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to the high incidence of proliferative vitreoretinopathy (PVR) after surgery, the primary anatomic reattachment rate was reported to be less than 70% in RRDCD[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As the techniques of vitrectomy advanced and preoperative management (e.g., preoperative administration of steroids) improved, the anatomic success rate of RRDCD has increased to 81.8%[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, RRDCD remains a remarkable risk factor for primary surgical failures and poor prognosis of RRD[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Identifying the risk factor of RRDCD is of great significance for early intervention.\u003c/p\u003e \u003cp\u003eOur earlier study demonstrated that implementation of the emergency surgical protocol for RRD clearly reduced the treatment interval of RRD, resulting in improved prognoses for affected patients\u003csup\u003e[12]\u003c/sup\u003e. However, it is still unclear whether the incidence of RRDCD changes after prompt emergency surgical intervention based on existing literature. This study aims to determine whether the implementation of the emergency surgical pattern contributes to a decreased incidence of RRDCD and to identify potential risk factors associated with occurrence of RRDCD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe medical records of patients who underwent RRD surgery at the Zhongshan Ophthalmic Centre (ZOC) were reviewed retrospectively, and patients complicated with RRDCD were identified. The Institutional Review Board of ZOC granted a waiver of informed consent for this research due to its retrospective nature.\u003c/p\u003e \u003cp\u003ePatients with RRD who underwent routine inpatient surgery between October 2019 and December 2020 were enrolled as the routine inpatient surgery group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We implemented an emergency protocol for RRD from January 2021 to provide urgent care for RRD patients. Those individuals who fulfilled the criteria for the emergency surgical protocol and underwent emergency surgery between January 2021 and March 2022 were categorized into the emergency surgery group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The indications for emergency surgery in cases of RRD are as follows: 1) RRD with macular-on; 2) RRD with macular-off lasting less than 3 days. Macular status was verified by slit lamp examination, fundus color photography, and optical coherence tomography.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRRDCD was diagnosed by ultrasound B-scan, ultrasound biomicroscope (UBM), slit lamp examination, or intraoperative findings. The number of retinal breaks and extent of RRD were verified by slit lamp examination, color fundus photography, or intraoperative condition.\u003c/p\u003e \u003cp\u003eDemographics, refractive status (high myopia was defined as a spherical equivalent refraction of \u0026minus;\u0026thinsp;6.0 D or less), macular status, lens status, extent of RRD, number of retinal breaks, duration of RRD, and the incidence rate of RRDCD were recorded and compared. As total retinal detachment has been reported to be a risk factor for RRDCD[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], patients were stratified into two groups based on the extent of retinal detachment: those with a retinal detachment extent less than or equal to 3 quadrants and those with a retinal detachment extent equal to 4 quadrants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion/Exclusion Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) all participants aged from 18 to 85 years; (2) a diagnosis of RRD was established based on slit lamp examination with a 90-diopter lens, ultrasound B-scan or color fundus photography; and (3) we investigated whether choroidal detachment occurred with RRD by clinical examinations or intraoperative findings.\u003c/p\u003e \u003cp\u003eExclusion criteria included: (1) a diagnosis of exudative RRD or tractional RRD; (2) history of age-related macular degeneration, diabetic retinopathy, retinal artery or vein occlusion; and (3) history of intravitreal injection, retinal photocoagulation or other intraocular treatment (except for uneventful cataract surgery).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIBM SPSS 20.0 software (SPSS Inc, Chicago, IL, USA) was employed for statistical analysis. Quantitative data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range, IQR), and analyzed by t test or Mann-Whitney U test. Categorical data were expressed as frequency and analyzed by chi-squared test. The independent risk factors for RRDCD were analyzed by binary logistic regression analysis. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was regarded as statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eThe Emergency Surgery Group vs. The Routine Inpatient Surgery Group\u003c/h2\u003e \u003cp\u003eBased on the eligibility criteria, 694 eyes from 694 patients underwent emergency surgery, while 692 eyes from 692 patients received routine inpatient surgery.\u003c/p\u003e \u003cp\u003eCompared to the routine inpatient surgery group, patients in the emergency surgery group had a lower proportion of RRDCD (2.88% vs. 10.84%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the emergency surgery group, the median (IQR) duration of RRD was 5 (3\u0026ndash;10) days and 72.77% of patients experienced vision loss for less than or equal to 7 days. However, in the routine inpatient surgery group, the median (IQR) duration of RRD was 15 (10\u0026ndash;30) days and only 17.92% of patients experienced vision loss for less than or equal to 7 days, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no significant difference in age (46.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.21 years vs. 47.22\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70 years), gender (male accounted for 68.15% vs. 66.91%), the status of refraction (high myopia accounted for 24.50% vs. 21.39%), the status of the macula (macular hole accounted for 2.88% vs. 2.31%), lens status (phakia accounted for 90.63% vs. 90.03%), number of retinal tears (\u0026gt;\u0026thinsp;1 accounted for 28.53% vs. 29.48%) and extent of RRD (4 quadrants accounted for 7.64% vs. 10.40%) between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and demographics of the emergency surgery group and the routine inpatient surgery group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency surgery group\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation or No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInpatient surgery group\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation or No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients / No. of eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e694/694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e692/692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years \u003csup\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.22\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender \u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e473 (68.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e463(66.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221(31.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229(33.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected eye\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e390(56.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e405(58.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e304(43.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e287(41.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh myopia\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170(24.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148(21.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacular hole\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens status\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e629(90.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e623(90.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudophakic/Aphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(9.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(9.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of retinal tears\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e496(71.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e488(70.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198(28.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204(29.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of retinal detachment\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 quadrants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e641(92.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e620(89.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 quadrants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53(7.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(10.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of RRD\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e505(72.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124(17.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189(27.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e568(82.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith choroidal detachment\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(10.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eRRD\u0026thinsp;=\u0026thinsp;rhegmatogenous retinal detachment\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger;by Mann-Whitney U test; \u0026Dagger;by chi-squared test; * Indicates \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRRD Group vs. RRDCD Group\u003c/h2\u003e \u003cp\u003eA total of 1386 RRD patients (1386 eyes) in both emergency and routine inpatient surgery group were studied, 95 patients (95 eyes) diagnosed with RRDCD in RRDCD group and 1291 patients (1291 eyes) without choroidal detachment in RRD group. Clinical and demographics data of RRD group and RRDCD group were presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The RRDCD group had more patients with pseudophakic/aphakic eyes, multiple retinal tears, total retinal detachment, and longer duration than RRD Group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The following variables were designated as categorical variables: lens status (phakia vs. pseudophakia/aphakia), numbers of retinal tears (1 vs. \u0026gt;1), extent of retinal detachment (\u0026le;\u0026thinsp;3 quadrants vs. 4 quadrants), and duration of RRD (\u0026le;\u0026thinsp;7 days vs. \u0026gt;7 days). Binary Logistic regression analysis revealed that pseudophakia/aphakia [OR 2.74, 95% CI (1.50\u0026ndash;4.98)], multiple retinal tears [OR 1.67, 95% CI (1.03\u0026ndash;2.70)], total retinal detachment [OR 11.58, 95% CI (7.12\u0026ndash;18.84)], and a prolonged duration (\u0026gt;\u0026thinsp;7 days) [OR 3.51, 95% CI (1.98\u0026ndash;6.23)] were identified as independent risk factors for RRDCD (All P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and demographics of the RRD eyes with and without choroidal detachment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRRD without CD\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation or No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRRD with CD\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation or No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients / No. of eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1291/1291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95/95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years \u003csup\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.57\u0026thinsp;\u0026plusmn;\u0026thinsp;14.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e865 (67.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (74.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e426 (33.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (25.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected eye\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e739 (57.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (58.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e552(42.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (41.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh myopia\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299(23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacular hole\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(2.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(4.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens status\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1179 (91.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (76.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudophakic/Aphakic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (8.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of retinal tears\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e929 (71.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (57.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e362 (28.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (42.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtent of retinal detachment\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 quadrants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1212 (93.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (51.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 quadrants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (6.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (48.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of RRD\u003csup\u003e\u003cb\u003e\u0026Dagger;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e612 (47.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (17.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e679 (52.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (82.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eRRD\u0026thinsp;=\u0026thinsp;rhegmatogenous retinal detachment;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCD\u0026thinsp;=\u0026thinsp;choroidal detachment.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger;by Mann-Whitney U test; \u0026Dagger;by chi-squared test; * Indicates \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; ** Indicates \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe 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[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 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 (\u0026gt;\u0026thinsp;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.\u003c/p\u003e \u003cp\u003eConsistent with prior research[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], 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[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Mariantonia et al found that compared with phakic RRD, pseudophakic RRD had greater RD extent and PVR[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Based on the findings of the above study, pseudophakia/aphakia may be associated with RRDCD by exerting an influence on the vitreous and PVR[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], subsequently impacting the extent of retinal detachment.\u003c/p\u003e \u003cp\u003eMost studies suggested that RRDCD was associated with multiple retinal tears[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Yu et al found that total RRD might be the potential risk factor for the development of RRDCD in RRD patients[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. 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 choroid\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAs 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[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], which is consistent with our finding. In the studies of Yu et al[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Gu et al[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], 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\u0026thinsp;\u0026le;\u0026thinsp;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.\u003c/p\u003e \u003cp\u003ePrevious reports showed that macular hole and high myopia were the risk factors for RRDCD[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. 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.\u003c/p\u003e \u003cp\u003eWe 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.\u003c/p\u003e \u003cp\u003eOur 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicting interest exists for any author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was granted from the Medical Scientific Research Foundation of Guangdong Province, China [C2022060] and the Natural Science Foundation of Guangdong Province, China [2020A1515111108]. The funders had no role in the design and conduct of this work, preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailable from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethical Review Committee of Zhongshan Ophthalmic Centre (Ethics Approval Number: 2022KYPJ054).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu Z, Ding N, Yu M, Wang K, Luo S, Zou W et al. Identification of Potential Biomarkers for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment by Vitreous iTRAQ-Based Proteomic Profiling. Int J Mol Sci. 2016; 17(12).\u003c/li\u003e\n\u003cli\u003eLi Z, Li Y, Huang X, Cai XY, Chen X, Li S et al. Quantitative analysis of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese using UBM. Retina (Philadelphia, Pa). 2012; 32(10):2020-2025.\u003c/li\u003e\n\u003cli\u003eSeelenfreund MH, Kraushar MF, Schepens CL, Freilich DB. Choroidal detachment associated with primary retinal detachment. Arch Ophthalmol. 1974; 91(4):254-258.\u003c/li\u003e\n\u003cli\u003eJarrett WH, 2nd. Rhematogenous retinal detachment complicated by severe intraocular inflammation, hypotony, and choroidal detachment. Trans Am Ophthalmol Soc. 1981; 79:664-683.\u003c/li\u003e\n\u003cli\u003eSharma T, Gopal L, Badrinath SS. Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment. Ophthalmology. 1998; 105(12):2282-2285.\u003c/li\u003e\n\u003cli\u003eSharma T, Challa JK, Ravishankar KV, Murugesan R. Scleral buckling for retinal detachment. Predictors for anatomic failure. Retina (Philadelphia, Pa). 1994; 14(4):338-343.\u003c/li\u003e\n\u003cli\u003eZhu J, Xu X, Zhang X. [Surgical therapeutic results of rhegmatogenous retinal detachment associated with choroidal detachment]. Zhonghua Yan Ke Za Zhi. 2002; 38(3):135-139.\u003c/li\u003e\n\u003cli\u003eGhoraba HH. Primary vitrectomy for the management of rhegmatogenous retinal detachment associated with choroidal detachment. Graefes Arch Clin Exp Ophthalmol. 2001; 239(10):733-736.\u003c/li\u003e\n\u003cli\u003eWei Y, Wang N, Chen F, Wang H, Bi C, Zu Z et al. Vitrectomy combined with periocular/intravitreal injection of steroids for rhegmatogenous retinal detachment associated with choroidal detachment. Retina (Philadelphia, Pa). 2014; 34(1):136-141.\u003c/li\u003e\n\u003cli\u003eSharma T, Gopal L, Reddy RK, Kasinathan N, Shah NA, Sulochana KN et al. Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study. Retina (Philadelphia, Pa). 2005; 25(2):152-157.\u003c/li\u003e\n\u003cli\u003eAdelman RA, Parnes AJ, Michalewska Z, Ducournau D, European Vitreo-Retinal Society Retinal Detachment Study G. Clinical variables associated with failure of retinal detachment repair: the European vitreo-retinal society retinal detachment study report number 4. Ophthalmology. 2014; 121(9):1715-1719.\u003c/li\u003e\n\u003cli\u003eChen Z, Gao K, Lai K, Zheng W, Li J, Liu Y et al. Effects of the Implementation of an Emergency Surgical Pattern in Patients with Rhegmatogenous Retinal Detachment: A Retrospective Observational Study. Journal of ophthalmology. 2022; 2022:4240225.\u003c/li\u003e\n\u003cli\u003eFerrara M, Mehta A, Qureshi H, Avery P, Yorston D, Laidlaw DA et al. Phenotype and Outcomes of Phakic Versus Pseudophakic Primary Rhegmatogenous Retinal Detachments: Cataract or Cataract Surgery Related? Am J Ophthalmol. 2021; 222:318-327.\u003c/li\u003e\n\u003cli\u003eYu Y, An M, Mo B, Yang Z, Liu W. Risk factors for choroidal detachment following rhegmatogenous retinal detachment in a chinese population. BMC ophthalmology. 2016; 16:140.\u003c/li\u003e\n\u003cli\u003eGu YH, Ke GJ, Wang L, Gu QH, Zhou EL, Pan HB et al. Risk factors of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese patients. Int J Ophthalmol. 2016; 9(7):989-993.\u003c/li\u003e\n\u003cli\u003eRahman N, Harris GS. Choroidal detachment associated with retinal detachment as a presenting finding. Can J Ophthalmol. 1992; 27(5):245-248.\u003c/li\u003e\n\u003cli\u003eMahroo OA, Dybowski R, Wong R, Williamson TH. Characteristics of rhegmatogenous retinal detachment in pseudophakic and phakic eyes. Eye (London, England). 2012; 26(8):1114-1121.\u003c/li\u003e\n\u003cli\u003eKuhn F, Aylward B. Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res. 2014; 51(1):15-31.\u003c/li\u003e\n\u003cli\u003eLi J, Zhao M, She H, Chandra A. The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services-Experiences from the Tongren eye center in Beijing. PloS one. 2021; 16(8):e0254751.\u003c/li\u003e\n\u003cli\u003eKang JH, Park KA, Shin WJ, Kang SW. Macular hole as a risk factor of choroidal detachment in rhegmatogenous retinal detachment. Korean J Ophthalmol. 2008; 22(2):100-103.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Brien K. The effect of the male-female body-size difference on absorbed dose-rate distributions in humans from natural gamma rays. Health Phys. 1978; 34(1):107-112.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"rhegmatogenous retinal detachment with choroidal detachment, ophthalmic emergency, rhegmatogenous retinal detachment.","lastPublishedDoi":"10.21203/rs.3.rs-3988319/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3988319/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eTo compare the proportion of rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) in the emergency surgery group with the routine inpatient surgery group and determine risk factors for RRDCD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eA total of 694 patients (eyes) diagnosed with rhegmatogenous retinal detachment (RRD) in the emergency surgery group were included from the Department of Ophthalmic Emergency, and 692 patients (eyes) in the routine inpatient surgery group were selected randomly from the Ocular Fundus Department. Demographics, refractive status, macular status, lens status, extent of retinal detachment, number of retinal breaks, duration of symptoms before surgery, and the incidence of RRDCD were compared. A logistic regression analysis was used to determine potential risk factors for RRDCD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Compared to the routine inpatient surgery group, the emergency surgery group had a significant less median time to surgery (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) and a decreased proportion of RRDCD (2.88% vs. 10.84%, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Logistic regression analysis revealed that a prolonged duration of RRD [OR 3.51, 95% CI (1.98-6.23)], pseudophakia/aphakia status [OR 2.74, 95% CI (1.50-4.98)], multiple retinal breaks [OR 1.67, 95% CI (1.03-2.70)], and a substantial extent of RRD [OR 11.58, 95% CI (7.12-18.84)] were independent risk factors for RRDCD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eEmergency surgical pattern of RRD demonstrated a lower incidence of RRDCD. The adoption of an expedited surgical approach has the potential to reduce the duration of RRD, possibly correlating with a decreased risk of RRDCD development.\u003c/p\u003e","manuscriptTitle":"New insights into an old problem: Rethinking the risk factor of rhegmatogenous retinal detachment associated with choroidal detachment from the viewpoint of treatment patterns: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 16:14:49","doi":"10.21203/rs.3.rs-3988319/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa40ef3b-5804-4ac6-b75c-ea079ef165bd","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30805404,"name":"Health sciences/Risk factors"},{"id":30805405,"name":"Health sciences/Diseases/Eye diseases/Retinal diseases"}],"tags":[],"updatedAt":"2024-06-11T15:05:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-31 16:14:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3988319","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3988319","identity":"rs-3988319","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}