Purchase this article with an account.
Kirk Packo, Joseph Civantos, Jack Cohen, John Pollack, Pauline Merrill, Serge de Bustros, Bruce Garretson; The Management of Retinal Detachments in Patients with Severe Mental Disabilities. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4952.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Patients with severe mental disabilities commonly develop retinal detachment (RD) due to self abusive behavior. Pathology is often severe due to presentation delay. Postop care and intraocular pressure (IOP) checks are often difficult. Surgical success is often far less than normal patients. This is the largest review to date of severely mentally disabled patients treated for RD.
45 eyes/37 patients from 4 institutions underwent surgery for RD over a 21 year period. Preoperative, operative and postoperative records reviewed retrospectively. Acuity was not possible as patients were nonverbal. Results were defined as Probable Surgical Success (PSS) and Probable Surgical Failure (PSF). PSS required: 1. macula attached, 2. IOP controlled, 3. cornea clear, and 4. one or more present: a. monocular patient reaches for objects, b. eye photo-averse, c. disc color good. PSF defined if any of the following present: 1. macula detached, 2. IOP uncontrolled, 3. cornea decompensated, 4. monocular with nonvisual behavior, 5. not photo-averse, or 6. disc atrophic.
100% of patients had RD, with Grade C PVR in 78%. Other features: 96% - macula off; 42% - giant retinal tear; 22% - macular hole; 9% - dislocated lens; 22% - fellow eye phthisis; 22% - RD later in fellow eye. Surgery choice: laser wall-off (4%); buckle only (15%); vitrectomy & gas (TPPV-G) (16%); vitrectomy & oil (TPPV-O) (80%); inoperable (9%). 47% required ≥ 2 procedures; 15% ≥ 3 procedures. Mean follow-up: 6.3 yrs (6-183 mos.). PSS seen in 29/45 eyes (64%). PSS seen in: 71% of buckle-only (7 eyes); 43% in TPPV-G (7 eyes); 76% in TPPV-O (25 eyes). PSS was 57% in 7 eyes in which oil was removed, and 83% in 18 eyes with oil retained. PSF seen in 16/45 (36%). 3 eyes failed with fellow eye phthisical. 1 patient failed OU. Total blindness in 4/37 (9%). 540 postop exams reviewed. 47 EUA’s done. Fundus seen & IOP obtained in 215 exams (40%). IOP unable in 53% of exams. Fundus never seen in 10% patients. 24% never had IOP checked.
Overall PSS was 64%. TPPV-O with oil retention gave best results (83%)(p>0.01). Glaucoma and corneal problems common. Postop exams are difficult with IOP obtained in less than half of exams. EUA’s required commonly. Patients with severe mental handicap represent a difficult population however vision can be restored. The first eye should be considered for surgery since surgery often required in fellow eye.
This PDF is available to Subscribers Only