To determine features of rhegmatogenous retinal detachment predictive of anatomical success with surgical procedure.
All patients undergoing surgery at a tertiary referral practice had contemporaneous data collection in an electronic database. Overall, 847 eyes from 847 patients undergoing surgical procedure for rhegmatogenous retinal detachment were included in this study.
Mean age was 62.2 years with 60% male subjects and 56% right eyes. Mean postoperative follow-up was 9.6 months (range, 6 weeks to 10 years). With univariate analysis, the presence of superotemporal breaks was associated with a reduction in the chance of failed primary surgery (P = 0.005); detached inferonasal breaks (P = 0.002), proliferative vitreoretinopathy (PVR) (P < 0.0001), breaks in detached inferior retina (P < 0.0001), fovea off (P = 0.001), and 4-quadrant rhegmatogenous retinal detachment (P < 0.0001) increased the risk of failure. After multivariate analysis PVR, detached inferior breaks, increased number of breaks, and 4-quadrant detachment remained associated with an increased risk of failure, and superotemporal detached breaks with the reduced risk of failure (r2 = 0.08). For patients without PVR, only inferonasal detached breaks and 3 to 4 quadrants of detachment remained predictive of failure (r2 = 0.04). For patients with PVR (n = 120), multivariate analysis showed that PVR C4-12 and posterior breaks increased the failure risk and detached superotemporal breaks reduced the risk of failure (r2 = 0.22).
Number of breaks, inferior positioning of breaks, the extent of rhegmatogenous retinal detachment, and PVR are associated with failed primary surgery.
This study of 847 retinal detachment surgeries identifies baseline characteristics of the affected eye that are predictive of surgical success or failure. After multivariate analysis of proliferative vitreoretinopathy on presentation, detached breaks in the inferior retina and the extent of detachment were found to be associated with an increase risk of surgery failure.
Department of Ophthalmology, St Thomas' Hospital, London, United Kingdom.
Reprint requests: Tom H. Williamson, MD, FRCOphth, St Thomas' Hospital, Lambeth Palace Road, London, United Kingdom SE1 7EH; e-mail: Tom@retinasurgery.co.uk
None of the authors have any conflicting interests to disclose.
Supported by Eyehope (UK registered charity 1119866).