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L. Wickham, G. Ho Yen, C. Bunce, D. Wong, D. G. Charteris; Surgical Failure Following Primary Retinal Detachment Surgery - Risk Factors and Functional Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5201.
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To identify pre-operative features associated with surgical failure following vitrectomy using data collected in a large prospective randomised controlled trial. Outcomes of patients who re-detached were then examined in more detail.
553 patients were recruited as part of an RCT investigating use of 5-fluorouracil and low molecular weight heparin. Treatment status had little effect on success rates and did not therefore form part of the analyses. Univariate logistic regression analysis was used to find an association between failure and putative risk factors (age, duration of symptoms, pathological myopia, intraocular pressure, vitreous haemorrhage, previous lens extraction, uveitis, number of retinal quadrants detached, number and distribution of retinal breaks and grade C PVR).
79 patients (14%) re-detached following surgery, 31 failed due to PVR. Surgical failure was associated with previous lens extraction (p=0.05), number of retinal quadrants detached (p=0.001) and grade C PVR (p=0.006). Inferior breaks were not identified as a risk factor (p=0.6). Repeat retinal detachment surgery showed a minimal trend towards reduced visual acuity at 6 months providing PVR did not develop. PVR resulted in a significant deterioration in visual acuity.
Previous lens extraction, extent of retinal detachment and pre-operative PVR are risk factors for surgical failure following vitrectomy for primary retinal detachment. PVR was again confirmed as the major factor influencing visual outcomes.
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