EC Ophthalmology

Background: Tractional retinal detachment (TRD) is a vision-threatening condition in which the neurosensory retina is pulled off from the retinal pigment epithelium due to contraction and elevation of proliferative membranes over the vitreous or retinal surfaces that occur in the absence of retinal tears. Early detection and timely surgical interventions are crucial to prevent permanent visual impairment. Despite its clinical significance, there is limited evidence on TRD in Ethiopia, and to our knowledge, no a published study has specifically addressed this condition.

Objective: To determine the prevalence, clinical characteristics, and associated factors of TRD among patients at Menelik II Comprehensive Specialized Hospital, Addis Ababa, Ethiopia.

Methods: A hospital-based cross-sectional study was conducted from November 2023 to September 2025, among all newly diagnosed TRD patients, 164 patients (190 eyes). Data were collected through structured interviews and comprehensive ophthalmic examinations, including slit-lamp bio-microscopy, dilated fundus evaluation, and optical coherence tomography when available. Data were entered into Epi Data and analyzed using SPSS version 27. Descriptive statistics summarized clinical profiles, while logistic regression identified predictors of macula-off status and poor visual outcomes. Statistical significance was set at p < 0.05.

Results: Among 2,940 new retina clinic patients, 164 patients (190 eyes) were diagnosed with TRD, giving a prevalence of 5.6%. The majority were male (60.4%) and aged ≥50 years (54.9%). PDR was the leading cause, accounting for 78.9% of cases, followed by BRVO (7.4%), CRVO (4.2%), and other causes (9.5%). Macula-off TRD was observed in 72.1% of eyes and was significantly associated with symptom duration; 6 months (AOR = 2.88, p = 0.001) and living; 100 km from Addis Ababa (AOR = 1.96, p = 0.017). Poor glycemic control (AOR = 4.35, p = 0.001) and diabetes duration ≥10 years (AOR = 3.82, p = 0.001) were major predictors of PDR-related TRD. Severe visual impairment (6/60) was present in 72.6% of eyes. Macula-off status remained the strongest determinant of poor vision (AOR = 7.91, p = 0.001).

Conclusion: TRD is an important cause of severe visual impairment at Menelik II Hospital, predominantly due to advanced PDR. Late presentation with macula-off detachment is common. Strengthening diabetic retinopathy screening, improving access to laser and intravitreal treatments, and expanding vitreoretinal surgical capacity are essential to reducing preventable blindness. Further multicenter studies are recommended to estimate the national burden of TRD.

 Keywords: Tractional Retinal Detachment; Proliferative Diabetic Retinopathy; Macula-off TRD; Visual Impairment; Retina; Ethiopia

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