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Jeremias Gaston Galletti, Laura Iezzi, Pablo Raul Ruisenor Vazquez, Juan Pablo Francos, Javier Fernando Casiraghi; Anatomical outcome and associated factors after surgery for rhegmatogenous retinal detachment in two Argentine clinics. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4151.
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© ARVO (1962-2015); The Authors (2016-present)
Outcome data from eye surgeries in Argentina is scarce, yet much required to assess the quality of care. The purpose of this work was to determine the anatomical outcome and associated factors after surgery for rhegmatogenous retinal detachment in Argentina.
Retrospective chart review of patients operated by one surgeon from 2012 to 2016 in 2 different clinics (clinic #1 with 20-gauge and #2 with 23-gauge instrumentation). Anatomical outcome was defined as successful if the retina remained fully attached 30 days after tamponade extraction, as failure if the retina was not fully attached and no further surgery was deemed appropriate, or as indeterminate if tamponade was still present in the eye or another surgery was scheduled to attach the retina at the end of the study period. Logistic regression with all recorded preoperative variables was used to find anatomical outcome predictors.
163 cases were collected (89 [55%] in clinic #1), 4 of which were lost to follow-up and were not analyzed. Mean age was 62 years (17-97), 43% were female and 58% were phakic eyes. 5 days (median) passed from symptoms onset to first visit, and another 6 days (median) passed until the first surgery. At first surgery, 74% of eyes had macula-off detachment, 18% had only one detached quadrant and 26% had all quadrants affected, whereas proliferative vitreoretinopathy (PVR) was 52% grade 0, 23% grade A, 14% grade B, 10% grade C and 1% grade D. Surgical procedures were: pneumatic retinopexy (2%), scleral buckle (12%), vitrectomy (70%) and vitrectomy+buckle (16%). One surgery was performed in 71%, two surgeries in 18% and three surgeries in 11% of the cases, with 79% success, 10% failure and 11% indeterminate cases at the end of the study. True success rate was 89%. The only factors negatively associated with success were PVR grade (strongest) and pseudophakia. There was a significant difference between clinic #1 and #2 only in true success rate (86% vs 92%, p=0.02) and age (66 vs 56 years, p<0.001).
The elapsed time until surgery and the type of procedure reflect local aspects of the Argentine health system, yet PVR grade remains a universal failure factor. These findings also hint that small gauge vitrectomy might be of help to improving outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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