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Elaine Downie, Zack Oakey, Ian Holmen, Michael M Altaweel, Justin Gottlieb, Michael S Ip, T Michael Nork, Jonathan S Chang; Recurrent retinal detachment: Surgical practices and outcomes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6593.
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© ARVO (1962-2015); The Authors (2016-present)
Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss. The majority of patients achieve lasting re-attachment with a single procedure, but a number of patients require multiple surgeries. This study reviewed surgical practices and outcomes in treatment of patients with recurrent detachment.
Retrospective chart review of patients treated for RRD from 2012 to 2017 with failed initial repair. Patients who were under age 18, had less than 2 months of follow up, ocular trauma, tractional detachments and proliferative vitreoretinopathy (PVR) at the time of their initial surgery were excluded.
Of 343 patients treated for RRD, 41 patients had unsuccessful initial surgery. 27 of these met inclusion criteria, the rest were excluded due to PVR noted during the initial surgery. Average age was 63.8 years. Most patients (66.7%) were phakic at time of initial surgery. The macula was detached initially in 62.9%. The majority of patients (74.1%) underwent vitrectomy (PPV) with gas tamponade as their primary surgery, the remainder had scleral buckle placement (SB) alone. All patients who had PPV initially had perfluoropropane (C3F8) gas placed as a tamponade. Most of these patients (85.2%) developed recurrent detachment within 3 months of their initial surgery. The etiologies for re-detachment were PVR (63%), new / uncovered retinal break (30%), residual vitreous (3.7%) and one patient had no etiology documented. For the second procedure, 3 patients (11.1%) with initial SB, were treated with laser retinopexy alone. All other patients were treated with either PPV alone (48.1%) or combined PPV/SB (40.7%). Silicone oil tamponade was used in 15 patients (55.6%), 8 had C3F8 (29.6%), and one (3.7%) received sulfur hexafluoride (SF6). Eight patients (29.6%) achieved re-attachment following their second procedure. The rest required additional procedures. On average, patients had 3.2 surgeries for reattachment of the retina with a range of 2 to 6. At final follow up visits, 26 patients (96.3%) were attached on clinical exam. Final VA was 20/40 or better in 29.6%, 20/50-20/100 in 14.8%, and 20/100 or worse in 55.6%.
Patients who require more than one surgery for RRD have a high likelihood of achieving anatomical success, though a large percentage need more than 2 procedures to do so. Despite high re-attachment rates, a significant percentage of patients suffer from substantial visual morbidity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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