Clinical characteristics of delayed reversible loss of light perception following vitreoretinal surgery and risk factors influencing time to recovery

To evaluate the incidence and clinical features of delayed reversible loss of light perception (D-RLLP) following vitreoretinal surgery, including vitrectomy or silicone oil (SO) removal, and to identify risk factors influencing its recovery time.

This study retrospectively reviewed 19029 cases (19029 eyes) of vitreoretinal surgery performed between October 2016 and March 2024. Based on strict temporal criteria, postoperative loss of light perception was classified as immediate postoperative loss of light perception (IP-LLP), D-RLLP, and delayed permanent loss of light perception (D-PLLP). The incidence of reversible loss of light perception (RLLP) and its clinical features were evaluated. A multiple linear regression model was constructed to identify the independent predictors of the recovery time of D-RLLP.

Among 19029 vitreoretinal surgeries, 113 eyes (0.59%) experienced postoperative loss of light perception (LLP), including 32 eyes (28.32%) with IP-LLP, 78 eyes (69.03%) with D-RLLP, and 3 eyes (2.65%) with D-PLLP. The overall incidence of D-RLLP was 0.41% (78/19029). D-RLLP incidence was significantly higher following SO removal (0.89%, 33/3703) than general vitrectomy (0.29%, 45/15326; P<0.001). In 78 D-RLLP cases, the median recovery time was 47min (interquartile range: 28–71min), with 25.64% recovering in ≤30min, 64.10% in 30–60min, and 10.26% requiring >60min. Multivariate regression identified a history of hypertension (B=18.63, P=0.046) and intraocular pressure difference (B=1.77/min per mm Hg, P=0.011) as independent predictors of prolonged recovery time.

D-RLLP is a rare clinical event following vitreoretinal surgery, with a median recovery time of 47min, and the vast majority of affected eyes recovered within 1h. SO removal displayed a significantly higher RLLP incidence than vitrectomy. Importantly, a history of hypertension and greater intraocular pressure difference correlated significantly with an extended recovery time.