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C. R. Henry, D. J. Covert, D. P. Han, C. R. Sanchez, S. K. Bhatia; Risk Factors for Rhegmatogenous Retinal Detachment Following Pars Plana Vitrectomy for Epiretinal Membrane and Macular Hole. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6063.
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Rhegmatogenous retinal detachment (RRD) is a known complication of pars plana vitrectomy (PPV). This study investigated clinical and surgical risk factors for the development of RRD following PPV for macular epiretinal membrane (ERM) and macular hole (MH).
Retrospective, consecutive cohort study of all patients undergoing PPV for ERM or MH between 1/1/2004 and 12/31/2007 at an academic eye center. Patients with follow up less than 60 days after surgery were excluded. Logistic regression models were constructed to calculate risk ratios to determine important demographic, clinical, and surgical risk factors associated with RRD following macular surgery.
Of the 229 patients who met inclusion criteria, follow up averaged 490 days (range: 60-2088 d). Average age was 69.6 years (SD: 9.4); 96 patients were male (42%). Preoperative diagnosis was ERM in 124 patients and MH in 105 patients. RRD occurred in 11 patients (8.9%) after PPV for ERM and in 4 patients (3.8%) following PPV for MH (p=0.18). The median time between PPV and RRD diagnosis was 49 days (range: 7-193 d). Patients with a history of retinal tear requiring laser retinopexy prior to surgery were 6.1 times more likely than those without to develop postoperative RRD (p=0.006, CI95%: 1.7-22). Small incision transconjunctival approach was protective against the development of intraoperative retinal tears (risk ratio 0.27, p=0.009, CI95%: 0.10-0.72), but not postoperative RRD (p=0.36). The following factors did not affect postoperative RRD risk: lens status, family history RRD, lattice degeneration, high myopia, need for posterior hyaloid detachment at time of PPV, or development of new retinal tears at time of PPV. Patients who experienced RRD following PPV had an average final visual acuity of 20/252 compared to 20/69 in patients who did not experience RRD (p=0.016).
Small incision transconjunctival approaches were protective against intraoperative retinal breaks. Of the factors investigated, however, only patients with a history of laser retinopexy for retinal tear prior to PPV were found to have significantly increased risk of postoperative RRD. This underscores the importance of detailed perioperative fundus examination and appropriate discussion of RRD risk in the informed consent process for patients with previous retinal tears. The risk of RRD appeared to be clinically manageable in patients classically thought to be at high risk, such as those with high myopia and lattice degeneration.
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