A Review of Various Treatments for Retinal Detachment

Abstract

Abstract: : Purpose: To compare the outcomes, in terms of visual acuity and anatomic attachment, of pneumatic retinopexy, scleral buckle, or vitrectomy for patients who sustained a primary rhegmatogenous retinal detachment(RRD) uncomplicated by coexisting retinal conditions such as age–related macular degeneration or proliferative vitreoretinopathy (PVR). Methods:The clinical records of patients treated at Ochsner Hospital in New Orleans were accessed from 1997 through 2003. Inclusion criteria were patients with RRDs with at least 10 weeks follow–up. Patients' pre–op and post–op vision were recorded as well as anatomic attachment and any further need for surgery. Phakic status as well as whether moderate myopia was present (greater than –4 D ). Exclusion criteria were those detachments caused by trauma or with significant coexisting PVR. Those patients with age–related macular degeneration, retinopathy of prematurity, significant diabetic retinopathy, or any other coexisting macular condition affecting vision were excluded. Patients with lattice degeneration were not excluded. Results: Primary outcomes looked at in this study were those procedures which resulted in lasting attachment on the initial attempt and postoperative visual acuity. Characteristics included were phakic status, moderate to high myopia, and vision preoperatively. In the pneumatic retinopexy group, lasting reattachment was achieved in 67% overall, while 83.3% in phakic patients. Visual acuity of 20/50 or better was achieved in 72%, even though only 38.8% of this group had similar preoperative vision. Those patients undergoing a scleral buckle surgery initially, had lasting reattachment in 84.2% overall, and 81.2% in phakic patients. Postopertive vision of 20/50 or better was 84.2%, though 63.1% had preopertive vision of 20/50 or better. In the vitrectomy group, 85% of patients achieved final reattachment with this surgery alone overall, and 88.8% in phakic patients. 65% had 20/50 or better vision and 25% preoperatively were 20/50 or better. Conclusions: In this retrospective review of a limited number of patients undergoing treatment by the same surgeon over the course of 6 years, it appeared that pneumatic retinopexy achieved slightly less enduring effects overall, though similar results were accomplished in phakic patients. Eventually, patients in all 3 groups achieved similar postopertive vision. This study may then help to support the previosuly supported claim that pneumatic retinopexy is a cost–effective alternative to other treatments for primary rhegmatogenous detachment, but further surgery may be required.

Keywords: retinal detachment