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Rhegmatogenous retinal detachments: primary reattachment rates and visual outcomes over a 4-year period

  • Patrick J. Murtagh
  • Kirk A. Stephenson
  • Maedbh Rhatigan
  • Elizabeth M. McElnea
  • Paul P. Connell
  • David J. Keegan
Original Article
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Abstract

Background and Aims

To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success.

Methods

A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success.

Results

A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25–91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501).

Conclusions

This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.

Keywords

Complications Procedure type Retinal detachments Rhegmatogenous Success rate Visual success 

Notes

Compliance with ethical standards

This study was approved by Mater Misericordiae University Hospital Institutional Review Board (IRB) conducted in accordance with the Declaration of Helsinki and the Irish Data Protection Act.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Wilkinson CP (2004) Rhegmatogenous retinal detachment. Ophthalmology. Mosby, St Louis, pp 982–989Google Scholar
  2. 2.
    Shah V, Hall N, Goldacre MJ (2015) Retinal detachment in England: database studies of trends over time and geographical variation. Br J Ophthalmol 99(5):639–643.  https://doi.org/10.1136/bjophthalmol-2014-305774 CrossRefGoogle Scholar
  3. 3.
    Mitry D, Charteris DG, Fleck BW, Campbell H, Singh J (2010) The epidemiology of rhegmatogenous retinal detachment: geographical variation and clinical associations. Br J Ophthalmol 94(6):678–684.  https://doi.org/10.1136/bjo.2009.157727 CrossRefGoogle Scholar
  4. 4.
    Rumpf J (1976) Jules Gonin. Inventor of the surgical treatment for retinal detachment. Surv Ophthalmol 21(3):276–284CrossRefGoogle Scholar
  5. 5.
    Thompson JA, Snead MP, Billington BM, Barrie T, Thompson JR, Sparrow JM (2002) National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes. Eye (Lond) 16(6):771–777.  https://doi.org/10.1038/sj.eye.6700325 CrossRefGoogle Scholar
  6. 6.
    Schaal S, Sherman MP, Barr CC, Kaplan HJ (2011) Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques. Retina 31(8):1500–1504.  https://doi.org/10.1097/IAE.0b013e31820d3f55 CrossRefGoogle Scholar
  7. 7.
    Feltgen N, Walter P (2014) Rhegmatogenous retinal detachment--an ophthalmologic emergency. Dtsch Arztebl Int 111(1–2):12–21quiz 22.  https://doi.org/10.3238/arztebl.2014.0012 Google Scholar
  8. 8.
    Mikhail MA, Mangioris G, Casalino G et al (2017) Outcome of primary rhegmatogenous retinal detachment surgery in a tertiary referral centre in Northern Ireland - a regional study. Ulster Med J 86(1):15–19Google Scholar
  9. 9.
    Minihan M, Tanner V, Williamson TH (2001) Primary rhegmatogenous retinal detachment: 20 years of change. Br J Ophthalmol 85(5):546–548CrossRefGoogle Scholar
  10. 10.
    Sullivan PM, Luff AJ, Aylward GW (1997) Results of primary retinal reattachment surgery: a prospective audit. Eye (Lond) 11(Pt 6):869–871.  https://doi.org/10.1038/eye.1997.223 CrossRefGoogle Scholar
  11. 11.
    Schwartz SG, Flynn HW Jr, Mieler WF (2013) Update on retinal detachment surgery. Curr Opin Ophthalmol 24(3):255–261.  https://doi.org/10.1097/ICU.0b013e32835f8e6b CrossRefGoogle Scholar
  12. 12.
    Yorston DB, Williamson T, Aylward B et al (2015) The BEAVRS retinal detachment project: an online database to evaluate retinal detachment surgery outcomes. Invest Ophthalmol Vis Sci 56(7):3518–3518Google Scholar
  13. 13.
    Jackson TL, Donachie PH, Sparrow JM et al (2013) United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole. Ophthalmology 120(3):629–634.  https://doi.org/10.1016/j.ophtha.2012.09.003 CrossRefGoogle Scholar
  14. 14.
    Rhatigan M, McElnea E, al MM t (2018) Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery. Int J Ophthalmol 11(1):83–88.  https://doi.org/10.18240/ijo.2018.01.15 Google Scholar
  15. 15.
    OECD (2014) Basic statistics of Ireland, vol 2015. OECD PublishingGoogle Scholar
  16. 16.
    Jackson TL, Donachie PH, Sparrow JM et al (2013) United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 1; case mix, complications, and cataract. Eye (Lond) 27(5):644–651.  https://doi.org/10.1038/eye.2013.12 CrossRefGoogle Scholar
  17. 17.
    Sallam AB, Donachie P, Yorston D et al (2017) Royal College of Ophthalmologists’ National Database Study of Vitreoretinal Surgery: report 7, intersurgeon variations in primary rhegmatogenous retinal detachment failure. Retina 134(1):79–85Google Scholar
  18. 18.
    Cheng L, Azen SP, El-Bradey MH et al (2001) Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study. Am J Ophthalmol 132(6):881–887CrossRefGoogle Scholar
  19. 19.
    Jackson TL, Donachie PH, Sallam A et al (2014) United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 3, retinal detachment. Ophthalmology 121(3):643–648.  https://doi.org/10.1016/j.ophtha.2013.07.015 CrossRefGoogle Scholar
  20. 20.
    Mansouri A, Almony A, Shah GK, Blinder KJ, Sharma S (2010) Recurrent retinal detachment: does initial treatment matter? Br J Ophthalmol 94(10):1344–1347.  https://doi.org/10.1136/bjo.2009.175968 CrossRefGoogle Scholar
  21. 21.
    Ross WH, Stockl FA (2000) Visual recovery after retinal detachment. Curr Opin Ophthalmol 11(3):191–194CrossRefGoogle Scholar
  22. 22.
    Wykoff CC, Schwartz SG, Adelman RA, Brucker AJ, Flynn HW Jr (2015) Primary rhegmatogenous retinal detachment repair: evidence supports an individualised approach. Br J Ophthalmol 99(11):1451–1453.  https://doi.org/10.1136/bjophthalmol-2015-307651 CrossRefGoogle Scholar
  23. 23.
    Silva RA, Flynn HW Jr, Ryan EH Jr et al (2013) Pars plana vitrectomy for primary retinal detachment: persistent anterior peripheral retinal detachment. JAMA Ophthalm 131(5):669–671.  https://doi.org/10.1001/jamaophthalmol.2013.646 CrossRefGoogle Scholar
  24. 24.
    Martinez-Castillo VJ, Garcia-Arumi J, Boixadera A (2016) Pars plana vitrectomy alone for the management of pseudophakic rhegmatogenous retinal detachment with only inferior breaks. Ophthalmology 123(7):1563–1569.  https://doi.org/10.1016/j.ophtha.2016.03.032 CrossRefGoogle Scholar
  25. 25.
    Kuhn F, Aylward B (2014) Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res 51(1):15–31.  https://doi.org/10.1159/000355077 CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Patrick J. Murtagh
    • 1
  • Kirk A. Stephenson
    • 1
  • Maedbh Rhatigan
    • 1
  • Elizabeth M. McElnea
    • 1
  • Paul P. Connell
    • 1
  • David J. Keegan
    • 1
  1. 1.Department of OphthalmologyMater Misericordiae University HospitalDublin 7Ireland

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