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Functional outcome and prognostic factors in 304 eyes managed by retinectomy

  • Clinical Investigation
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

This study was undertaken to relate the anatomic and functional results of patients who underwent retinectomy for complex retinal detachment (RD) to preoperative prognostic variables.

Methods

Three hundred and four eyes of 302 patients whose surgery involved retinectomy were included in the analysis. All eyes had established proliferative vitreoretinopathy (PVR grade C). The main outcome measures were (1) postoperative visual acuity of 6/24 or better, (2) status of the retina at the end of follow-up, and (3) incidence of hypotony whilst under review.

Results

PVR was secondary to rhegmatogenous RD in 237 eyes (78%), posterior trauma in 51 eyes (16.8%), tractional RD in vasoproliferative vasculitides in 12 eyes (4%), acute retinal necrosis in 2 eyes and endophthalmitis in 2 eyes. Complete reattachment rate after one operation was 51%, with final complete reattachment success rate of 72%. The visual acuity improved in 138 eyes (45%), remained the same in 73 eyes (24%) and became worse in 89 cases (29%). Postoperative visual acuity of 6/24 or better was significantly associated with preoperative vision, the duration of silicone oil tamponade, silicone oil removal and retinectomy size. There was also some evidence of association between visual outcome and the number of clock hours of retinal detachment. Final retinal attachment was significantly associated with silicone oil removal and preoperative vision, and final hypotony was significantly associated with silicone oil removal. The incidence of sympathetic ophthalmia in our study was 0.09% (one case).

Conclusions

Good functional outcome is possible following retinectomy surgery despite advanced pathology and often multiple surgical procedures. Retinal redetachment as a result of reproliferation and hypotony appear to be the main reasons for anatomical and functional failure. The clinical features we have identified as good indicators for improved final visual acuity such as shorter tamponade duration, removal of silicone oil, smaller retinectomy size, fewer previous operations and better preoperative vision are surrogate markers of less advanced PVR and should prompt retinal surgeons to consider retinectomy at an earlier stage in the process of PVR development. Clinicians should be aware of the small risk of sympathetic ophthalmia from complex retinal surgery.

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References

  1. Alturki WA, Peyman GA, Paris CL, Blinder KJ, Desai UR, Nelson NC Jr (1992) Posterior relaxing retinotomies: analysis of anatomic and visual results. Ophthalmic Surg 23:685–688

    PubMed  CAS  Google Scholar 

  2. Barr CC, Lai MY, Lean JS, Linton KL, Trese M, Abrams G, Ryan SJ, Azen SP (1993) Postoperative intraocular pressure abnormalities in the Silicone Study. Silicone Study Report 4. Ophthalmology 100:1629–1635

    PubMed  CAS  Google Scholar 

  3. Blumenkranz MS, Azen SP, Aaberg T, Boone DC, Lewis H, Radtke N, Ryan SJ (1993) Relaxing retinotomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy. Silicone Study Report 5. The Silicone Study Group. Am J Ophthalmol 116:557–564

    PubMed  CAS  Google Scholar 

  4. Bourke RD, Cooling RJ (1996) Vascular consequences of retinectomy. Arch Ophthalmol 114:155–160

    PubMed  CAS  Google Scholar 

  5. Bourke RD, Dowler JG, Milliken AB, Cooling RJ (1996) Perimetric and angiographic effects of retinotomy. Aust N Z J Ophthalmol 24:245–249

    PubMed  CAS  Google Scholar 

  6. Bovey EH, De Ancos E, Gonvers M (1995) Retinotomies of 180 degrees or more. Retina 15:394–398

    Article  PubMed  CAS  Google Scholar 

  7. Brown GC, Brown MM, Sharma S, Busbee B, Landy J (2002) A cost-utility analysis of interventions for severe proliferative vitreoretinopathy. Am J Ophthalmol 133:365–372

    Article  PubMed  Google Scholar 

  8. Eckardt C, Behrendt S, Zwick A (1992) Results of silicone oil removal from eyes treated with retinectomies. Ger J Ophthalmol 1:2–6

    PubMed  CAS  Google Scholar 

  9. Faude F, Lambert A, Wiedemann P (1998) 360 degrees retinectomy in severe anterior PVR and PDR. Int Ophthalmol 22:119–123

    Article  PubMed  Google Scholar 

  10. Federman JL, Eagle RC Jr (1990) Extensive peripheral retinectomy combined with posterior 360 degrees retinotomy for retinal reattachment in advanced proliferative vitreoretinopathy cases. Ophthalmology 97:1305–1320

    PubMed  CAS  Google Scholar 

  11. Gass JD (1982) Sympathetic ophthalmia following vitrectomy. Am J Ophthalmol 93:552–558

    PubMed  CAS  Google Scholar 

  12. Gremillion CM Jr, Peyman GA (1989) Posterior relaxing retinotomy. Ophthalmic Surg 20:655–657

    PubMed  Google Scholar 

  13. Han DP, Mieler WF, Abrams GW, Williams GA (1988) Vitrectomy for traumatic retinal incarceration. Arch Ophthalmol 106:640–645

    Article  PubMed  CAS  Google Scholar 

  14. Han DP, Lewis MT, Kuhn EM, Abrams GW, Mieler WF, Williams GA, Aaberg TM (1990) Relaxing retinotomies and retinectomies. Surgical results and predictors of visual outcome. Arch Ophthalmol 108:694–697

    PubMed  CAS  Google Scholar 

  15. Han DP, Rychwalski PJ, Mieler WF, Abrams GW (1994) Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection. Am J Ophthalmol 118:24–32

    PubMed  CAS  Google Scholar 

  16. Han DP, Pulido JS, Mieler WF, Johnson MW (1995) Vitrectomy for proliferative diabetic retinopathy with severe equatorial fibrovascular proliferation. Am J Ophthalmol 119:563–570

    PubMed  CAS  Google Scholar 

  17. Haut J, Larricart P, van Effenterre G (1984) Localized retinectomy indications in the treatment and prevention of retinal detachment. Ophthalmologica 188:212–215

    PubMed  CAS  Google Scholar 

  18. Haut J, Larricart P, Geant G, van Effenterre G, Vachet JM (1986) Circular subtotal retinectomy and inferior semicircular retinotomy. Material and results in 38 cases. Ophthalmologica 192:129–134

    PubMed  CAS  Google Scholar 

  19. Haut J, Monin C, Larricart P, van Effenterre G, Piaton JM, Flamand M (1989) Study of a new series of large relaxing retinotomies. Ophthalmologica 198:35–39

    Article  PubMed  CAS  Google Scholar 

  20. Iverson DA, Ward TG, Blumenkranz MS (1990) Indications and results of relaxing retinotomy. Ophthalmology 97:1298–1304

    PubMed  CAS  Google Scholar 

  21. Jacobs PM, Cooling RJ, Leaver PK, McLeod D (1987) Retinal relieving incisions. Eye 1(Pt 4):500–503

    PubMed  Google Scholar 

  22. Kilmartin DJ, Dick AD, Forrester JV (2000) Sympathetic ophthalmia risk following vitrectomy: should we counsel patients? Br J Ophthalmol 84:448–449

    Article  PubMed  CAS  Google Scholar 

  23. Kirchhof B (1994) Retinectomy lowers intraocular pressure in otherwise intractable glaucoma: preliminary results. Ophthalmic Surg 25:262–267

    PubMed  CAS  Google Scholar 

  24. Lesnoni G, Billi B, Rossi T, Stirpe M (1997) The use of panoramic viewing system in relaxing retinotomy and retinectomy. Retina 17:186–190

    PubMed  CAS  Google Scholar 

  25. Lewis H, Aaberg TM, Abrams GW (1991) Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy. Am J Ophthalmol 111:8–14

    PubMed  CAS  Google Scholar 

  26. Liddy L, Stuart J (1972) Sympathetic ophthalmia in Canada. Can J Ophthalmol 7:157–159

    PubMed  CAS  Google Scholar 

  27. Machemer R (1979) Cutting of the retina: a means of therapy for retinal reattachment (author’s transl). Klin Monatsbl Augenheilkd 175:597–601

    PubMed  CAS  Google Scholar 

  28. Machemer R (1981) Retinotomy. Am J Ophthalmol 92:768–774

    PubMed  CAS  Google Scholar 

  29. Machemer R, McCuen BW, de Juan E Jr (1986) Relaxing retinotomies and retinectomies. Am J Ophthalmol 102:7–12

    PubMed  CAS  Google Scholar 

  30. Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM (1991) An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol 112:159–165

    PubMed  CAS  Google Scholar 

  31. Morse LS, McCuen BW, Machemer R (1990) Relaxing retinotomies. Analysis of anatomic and visual results. Ophthalmology 97:642–647

    PubMed  CAS  Google Scholar 

  32. Reinking U, Lucke K, Bopp S, Laqua H (1990) Results after retinotomy and retinectomy in the treatment of complicated retinal detachment. Klin Monatsbl Augenheilkd 197:382–385

    Article  PubMed  CAS  Google Scholar 

  33. Schwartz SD, Kreiger AE (1998) Proliferative vitreoretinopathy: a natural history of the fellow eye. Ophthalmology 105:785–788

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Vitreoretinal Research Unit, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK

    Vlassis G. Grigoropoulos, Sarah Benson & David G. Charteris

  2. Medical Statistics, Research Directorate, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK

    Catey Bunce

  3. 1 Semitelou Street, Athens, 11528, Greece

    Vlassis G. Grigoropoulos

Authors
  1. Vlassis G. Grigoropoulos
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  2. Sarah Benson
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  3. Catey Bunce
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  4. David G. Charteris
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Correspondence to Vlassis G. Grigoropoulos.

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The above authors confirm that this manuscript is not related with any proprietary or commercial interests. No sponsoring organizations have been involved and no grants were received from any organization or institution.

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Grigoropoulos, V.G., Benson, S., Bunce, C. et al. Functional outcome and prognostic factors in 304 eyes managed by retinectomy. Graefe's Arch Clin Exp Ophthalmol 245, 641–649 (2007). https://doi.org/10.1007/s00417-006-0479-z

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  • DOI: https://doi.org/10.1007/s00417-006-0479-z

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