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E. de la Rua, Sr., J. Pastor, I. Fernández, J. García Arumí, V. Martínez – Castillo, R. Sanabria, I. Miranda, D. Sánchez, Retina 1 Project; Retinal Detachment Management in Spain: Variations in 5 Years. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5714.
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to assess variations in the management of non complicated rhegmatogenous retinal detachments (RD) in two series separated by 5 years.
Prospective, multicentric study involving 5 hospitals. Consecutive cases of RD were included and 83 variables related to preoperative characteristics, surgical management and postoperative evolution were recorded. All surgeons were experienced and were allowed to treat patients following their personal criteria. Group 1(G1) (n: 186) includes cases operated from 1999 to 2001; group 2 (G2) (n: 153) includes cases from 2004 to 2006. Quantitative variables were compared by Mann-Whitney U test. Qualitative variables were analysed by standard contingency tables. Logistic regression models were used to evaluate the importance of RD characteristics for the decision to perform a vitrectomy.
G1 showed significant longer delayed in performing surgery since first symptoms occur (G1: 29 ± 50 days; G2: 22 ± 55; p < .001) and more RD without visible retinal break than G2 (G1:17.4%; G2: 9.2%; p = .028). In G2 cases with multiple retinal breaks (G1: 31.6%; G2: 44.6%) were more frequent (p = .022). No significant differences in other preoperative variables were observed. Vitrectomy was performed in 30.1% in G1 and in 78.4% in G2 as a primary surgical approach (p < .001). Independently of the RD characteristics, rate of vitrectomy was higher in G2. In G1 vitrectomy was mainly associated to non visible retinal breaks (OR: .110; CI 95%: .029 - .424) or vitreous haemorrhage (OR: 3.410; CI 95%: 1.104 - 10.538). In G2 cases with PVR grade A or B (OR: 6.198; CI 95%: 1.344 - 28.582) and pseudophakia (OR: 28.694; CI 95%: 3.762 - 218.864) went to vitrectomy. Reattachment rate was over 94% in both groups (p = .833). Only pseudophakic RD showed better anatomical results in G2 than in G1 (G1: 83.9%; G2: 96.4%; p = .028).
There is a increasing tendency to treat RD with primary vitrectomy in the last 5 years, neither related with a higher complexity of cases nor with better anatomical results.
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