Author: Alvaro Silva
Co-authors: Keissy Sousa, Carlos Cruz, Margarida Fertusinhos, Gil Santos, Luis Mendonca, Nuno Gomes, Christophe Pinto, Rui Silva
Abstract
PurposeRhegmatogenous retinal detachment (RRD) is a major cause of ocular morbidity and requires an urgent therapeutic approach. The current surgical techniques provide high rates of anatomical success but the functional outcome remains uncertain.
Here we attempt to identify factors associated with surgical and functional outcomes in RRD surgery.
Setting
Department of Ophthalmology, Hospital de Braga, Braga, Portugal
Methods
A retrospective, cohort study was designed. The study enrolled 496 eyes from 496 patients submitted to surgical correction from 2012 to 2017. Sociodemographic; clinical: Corrected Distance Visual Acuity (CDVA), intraoperative macula status (on/off); presence of myopia (≤ -3 diopters); presence of pseudophakia and previous history of RRD in contralateral eye; and surgical data: time to surgery; surgical technique (Pars Plana Vitrectomy alone or combined with scleral buckling); Internal Limiting Membrane (ILM) peeling; type of tamponade used; deleterious factors (hemovitreous, macular hole and retinal dialysis) were collected.
Anatomic success was defined as complete application of the retina at the end of follow-up. Surgical success was defined as a CDVA <0.4 logMAR. All subjects were evaluated preoperatively and at 1, 3, 6 and 12 postoperatively.
Results
The mean age of RRD diagnosis was 60,9±13,3 years. At diagnosis, 77,5 % of patients presented with macula-off and 22.5% with macula-on. Preoperative CDVA was 2.0 ±1,2 logMAR and 0,2 ±0,4 logMAR postoperatively, at 12 months of follow-up. Isolated Pars Plana Vitrectomy was carried in 92,1% of patients and median time to surgery was 4 days. Primary surgical success was obtained in 86,7% with 13% of retinal redetachments. Regarding surgical outcome the presence of myopia was associated with increased chances of attaining anatomic success (OR=1,94, p=0,03). On the other hand, the presence of deleterious factors (ie., hemovitreous, macular hole and retinal dialysis) was associated with decreased chances of obtaining surgical success (OR=0,52, p=0,03). The functional sucess was achieved in 64% of patients. The presence of macula-off (OR=0,20, p<0,01), peeling of ILM (OR=0,44, p<0,01), and the use of silicone as tamponade (OR=0,07, p<0,01) were all associated with decreased chances of attaining functional outcome.
Preoperative CDVA and time to surgery revealed significative association as predictive factors in univariate analysis but lost significance in the multivariate model.
Conclusion
The presence of certain clinical and surgical factors can be used to predict functional and surgical success in RRD surgery. Given its substantial visual morbidity, the definition of independent predictive factors for RRD surgical correction is fundamental for a comprehensive and personalized care.
Financial Disclosures: none to declare.
