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G. D. lee, D. B. Roth, A. N. Kahan, J. Prenner, B. Keyser, H. Fine; Retinal Detachment Repair Outcomes in Patients With Prior Posterior Segment Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6073.
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To evaluate the outcomes and success rate of rhegmatogenous retinal detachment (RD) surgery in patients who have never had previous posterior segment surgeries versus patients who have.
Clinical records were reviewed for 562 cases where scleral buckle (SB), pars plana vitrectomy (PPV), or SB+PPV was performed for RD codes during the period of January 2004 - Dec 2008 by one of eight vitreoretinal specialists at the Retina Vitreous Center at Robert Wood Johnson Medical School in New Jersey.
Of 562 total eyes, 20 of them had previous posterior segment (PS) surgeries with the following diagnoses: 6 epiretinal membrane, 5 macular hemorrhage, 2 proliferative diabetic retinopathy, 2 ruptured globe, 2 retained cataract fragments, 1 endophthalmitis, 1 choroidal neovascular membrane, and 1 vitreomacular traction. In the total cohort, 45% of all the cases presented with macula-on RD while 55% were macula-off RD; 33% presented with inferior retinal holes. In the cohort without previous RD surgery, there was a 91% initial success rate at 3 months, while in cohort with previous PS surgery, the initial success rate was 70%. After 6 months and additional procedures, the previous PS cohort also achieved 90% success rates. The previous PS surgery cohort required an average of 1.75 procedures for RD repair (including initial procedure) while the no previous surgery cohort required 1.2 surgeries. Using Logmar conversion, the previous PS surgery cohort initially had a Snellen equivalent visual acuity (VA) of 20/1003 prior to their initial surgery, 20/6124 prior to RD surgery, and 20/855 at 6 months post-RD surgery. The improvement in vision from pre-RD surgery to final was significant (p=0.019). Ten of the eyes in the prior PS surgery cohort worsened visually from prior to PS surgery compared with 6 months after RD surgery, but as a cohort it was not statistically significant (Snellen equivalent 20/1002 --> 20/855; p=0.77).
The results of this study suggest that patients with prior PS surgery who develop RD have a higher likelihood of initial failure, more often requiring additional procedures for repair of postoperative RD.
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