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Zaid Mammo, Rosanna Martens, Andrew Merkur, Andrew Kirker, David Albiani, C Gustavo De Moraes, Stanley Chang, David Maberley; Surgical Success and Functional Outcomes of Failed Pneumatic Retinopexy for Primary Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4248. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the functional and anatomical outcomes of patients who failed pneumatic retinopexy (PR) as a primary treatment for rhegmatogenous retinal detachment (RRD).
Retrospective consecutive case series of all failed primary PRs at a tertiary referral centre. Six-month anatomical and functional outcomes of secondary interventions were compared: scleral buckle (SB), pars-plana vitrectomy (PPV) and combined PPV and SB (PPV+SB). The data was analyzed using Fisher’s exact test and ANOVA.
Out of 267 patients with RRD treated with PR over 18 months, 73 failed cases were included. All patients had six-month follow-up data. Average time to failure was 12 +/-29 days (SD). Among failed cases, 60% required a secondary intervention within 3 days of the original procedure. Missed or new retinal tears were responsible to almost 50% of all failures. Percentage of failures attributed to proliferative vitreoretinopathy (PVR) was 4%, 20% and 44% in the PPV, SB and PPV+SB group, respectively (p<0.01). At time of failure, a trend towards increased macula-involved RRD was noted in the combined PPV+SB group (78%), SB (47%) and PPV (47%)(p=0.34). The combined single secondary intervention anatomical success rate post-failed PR was 93% (SB (87%, n=15), PPV (96% n=49), and PPV+SB (89%, n=9) (p=0.33)). Visual acuity (logMAR [Snellen acuity equivalent]) at initial presentation and post-PR failure were similar for the SB (1.01 [20/202] and 0.76 [20/116], PPV (1.07 [20/237] and 0.98 [20/189] and PPV+SB (1.36[20/459] and 1.58[20/764]) groups (p=0.71 and p=0.14), respectively. Both the SB (0.18[20/30]) and PPV (0.28[20/38]) groups had better VA at final follow-up compared to the combined SB+PPV group (0.92 [20/166] (p<0.01).
Among patients who failed PR for RRD, there were equivalent anatomical outcomes observed for SB, PPV and PPV+SB. However, patients receiving SB and PPV had superior functional outcomes at six-month follow up compared to PPV+SB. This may be influenced by the the greater percentage of PVR at time of failure and trends towards increased macula-involvement at that point, as well as trends of worse initial and post-PR failure visual acuity within the PPV+SB group.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Anatomical and functional outcomes of secondary interventions after failed pneumatic retinopexy for rhegmatogenous retinal detachment. Visual acuity (VA) (logMAR[Snellen acuity equivalent]).
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