Abstract
Purpose :
The clinical course and outcomes of patients with advanced chronic retinal detachments (RDs)—detachments greater than one month—have not been well-studied. The goal of this case series was to investigate the outcomes associated with surgical intervention of advanced chronic macula-off RDs.
Methods :
Thirty-eight patients that presented to Denver Health Medical Center, a safety-net hospital system, from 2016 to 2021, with a retinal detachment that was not repaired for greater than one month were identified. These patients were analyzed for proliferative vitreoretinopathy (PVR) on presentation, type of surgical intervention, pre-operative and final best-corrected visual acuity (BCVA), initial surgical re-attachment rate, final surgical attachment rate, and occurrence of phthisis. Additionally, post-operative complications were identified and recorded including ocular hypertension and cataract formation.
Results :
Mean duration of RD was 153 days. Twenty-eight out of 38 (74%) patients had PVR on initial presentation. Initial surgical intervention included pars plana vitrectomy (PPV) without scleral buckle (SB) (5%), pars plana vitrectomy with scleral buckle (79%), and scleral buckle with cryotherapy (16%). Initial attachment rate was 55.26% and the final attachment rate was 94.74%. Mean number of RD surgeries was 1.50 (SD 0.77). All six patients who underwent SB with cryotherapy failed initial surgery and required PPV. Other post-operative complications included ocular hypertension (76%), cataract formation (66%), and phthisis bulbi (5%). Of patients that developed ocular hypertension, 7/29 (24%) required surgery. Mean final BCVA was 1.60 (0.71) and final globe salvage rate was 38/38 (100%).
Conclusions :
We demonstrate the clinical characteristics of advanced chronic RDs with various surgical approaches. We found that initial retinal reattachment in advanced chronic RD was much lower than reported rates of uncomplicated acute RDs. Additionally, a majority of patients developed ocular hypertension and almost a quarter of whom required surgical management. Finally, primary scleral buckle might be less successful in advanced chronic RDs. Poor patient compliance with post-operative positioning and follow-up also appeared to affect patient outcomes. However, most patients had successful final re-attachment, globe salvage, and ambulatory vision. Further studies are needed to optimize surgical outcomes in these patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.