Anatomical and functional outcomes of surgery of rhegmatogenous retinal detachment

Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling

AIM

To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB).

METHODS

Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement.

RESULTS

Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, P<0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P=0.0250), better baseline BCVA (r=0.7291, P<0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR(2))=0.5316, P<0.0001], shorter symptoms duration (PR(2)=0.0609, P=0.0101), longer follow up duration (PR(2)=0.0278, P=0.0477) and shorter operative duration (PR(2)=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0.0067).

CONCLUSION

Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.

Seasonal Variation in the Occurrence of Rhegmatogenous Retinal Detachment

PURPOSE

Seasonal predilection is reported in the occurrence of various systemic and ocular diseases. An attempt was made to evaluate the existence of such an association in the development of rhegmatogenous retinal detachment (RRD). The aims of the study were to investigate the existence of seasonal variation in the occurrence of RRD and to analyze the predisposing factors for such variation.

DESIGN

This was a retrospective review.

METHODS

A retrospective review of all cases of RRD during a period of 2 years (June 2012 to May 2014) was carried out. The details regarding demographic profile, clinical features, and the month of occurrence of RRD were collected. Climatic parameters such as temperature, relative humidity, rainfall, and number of sun hours were noted. The various factors were compared with SPSS version 17.0, and χ test was used for statistical analysis.

RESULTS

Of the 76 cases of RRD, 38.2% occurred in the hot humid summer months (P = 0.046) followed by 22.4% in the cool humid winter months. Subtotal retinal detachments were more common in summer (P = 0.015). Factors suggestive of vitreous dehydration such as posterior vitreous detachment, intraocular pressure, and intraocular pressure of fellow eye were not associated with this seasonal variation. The peak minimum temperature, peak maximum temperature, and sun hours were related to this finding. High relative humidity and low rainfall were also associated.

CONCLUSIONS

Rhegmatogenous retinal detachment shows definite seasonal variation which peaks in the summer months. Meteorological parameters may further play a role in determining the onset of retinal detachment.

Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study

Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.