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D. B. Roth, A. Kahan, S. Namburi, B. J. Keyser, J. L. Prenner, H. F. Fine, W. J. Feuer; Factors Associated With Success or Failure After Retinal Detachment Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6062.
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© ARVO (1962-2015); The Authors (2016-present)
Objective: To predict preoperative and surgical features of retinal detachment that influence success or failure after retinal detachment (RD) surgery.
Controversy exists regarding the ideal approach to repair rhegmatogenous retinal detachment: scleral buckle alone, vitrectomy alone, or combined scleral buckle and vitrectomy. Preoperative factors may influence outcome as well and deserve study.Herein, we evaluate preoperative and surgical features of retinal detachment that influence success or failure after retinal detachment (RD) surgery.
542 consecutive eyes undergoing scleral buckle, vitrectomy, or combined scleral buckle-vitrectomy were retrospectively reviewed. Surgery was performed by one of 8 vitreoretinal surgeons from a single group retina practice. Primary outcome measures were initial success, final success, visual improvement and development of proliferative vitreoretinopathy (PVR). Preoperative factors evaluated included preoperative visual acuity, lens status, use of glaucoma drops, prior laser or cryotherapy, macular status, the number of clock hours of RD, the number of retinal holes, and the presence of inferior holes, lattice degeneration, giant retinal tear or chronic RD.
45% of eyes presented with a macula-on RD and 52% presented with macula-off RD. 75% of eyes presented with 2 or fewer retinal holes and 33% of eyes presented with inferior retinal holes. Presenting visual acuity was 20/40 or better in only 36% of eyes. Total cohort initial success was 91%. After multivariate analysis, no significant difference in initial success was noted between the surgical techniques of scleral buckle alone, vitrectomy alone, or combined scleral buckle and vitrectomy. Increase number of clock hours of RD was associated with initial failure (p<0.001); for an additional 3 clock hours of RD, the odds ratio for initial failure is 1.7 times or 70% higher. Increase number of clock hours of RD was associated with development of PVR (p<0.001). Final success was decreased in eyes with worse preoperative visual acuity, suggesting chronicity of RD (p=0.015). Larger RD, preoperative visual acuity of 20/200 or worse and giant retinal ear were associated with a final visual acuity of worse than 20/40.
With appropriate case selection, scleral buckle alone, vitrectomy alone, or combined scleral buckle-vitrectomy all have a similar primary success rate. Extent of RD was the most important factor in predicting a worse initial anatomical outcome.
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