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Eva Smretschnig, Katharina Krepler, Christiane Isolde Falkner-Radler, Jessica Spörl, Susanne Binder; Surgery for primary rhegmatogenous retinal detachment- Anatomical and visual outcome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1086.
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To evaluate anatomical and functional outcome after surgery for primary rhegmatogenous retinal detachment and assess prognostic factors.
In a prospective cohort study all patients undergoing surgery for primary rhegmatogenous retinal detachment (RRD) in the years 2012 and 2013 were included.A total of 8 surgeons were performing the operations.Main outcome measures were single surgery success rate (SSSR), final anatomical SR and best corrected visual acuity(BCVA).Follow up was 6 months.Duration of symptoms, lens status, number of breaks, extent of detachment, status of the macula, PVR ,type of surgery and timing of surgery were assessed and correlated with outcome.
275 eyes of 275 patients were included (98f/177m),131 eyes presenting with a Macula-on RD (47.6%),mean extent of RRD was 4.9 hrs, a mean of 1.35 breaks were found preoperatively.166 patients were phakic (60.36%) of which 24(14.4%) redetached ,109 pseudophakic(39.6%), of which 9(8.3%) redetached.PVR grade C was found in 9.45%(26 pat.), of which 6(23%) redetached.232(84.3%) eyes were treated with primary vitrectomy (ppVE), 30 eyes(11%) with buckle procedure (SB) and 13(4.7%) eyes with a combination of ppVE+SB.SSSR was 88.3 % (245 eyes) and final success rate 98.1% (270 eyes)-no difference was found between emergency settings and planned surgery. Re-detachment (RD) rate was 10.7% (25 eyes) in the ppVE-, 13.3% (4 eyes) in the SB- and 30.7% (4 eyes) in the combined group. RD occured in 15.3% (4 eyes) with PVR grade C. RD occured at a mean of 5.7 weeks and 0.6 weeks after primary SSR.BCVA improved from 0.3 to 0.5 Snellen and was significantly better in Macula-on versus Macula-off RRD preoperatively (0.57 vs 0.17) and postoperatively (0.59 vs 0.34).
Macula-on RRD patients have a better visual prognosis,which makes earlier diagnosis of RRD desirable.Although final SSSR was high, there is still a chance to improve primary SSR both in ppVE and BS cases.In the past years, ppVE cases have increased in numbers, reducing the numbers of BS performed to only 10% of all cases.Especially young surgeons do not have the possibility to practice their skills on BS regularly, which will lead to an even less frequent performance of this surgical technique. We have to decide now, whether to abandon SB completely or to refine it but keep the main principle of external indentation of the hole for closure and release of vitreous traction.
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