Session Title: Free Paper Session 8: Vitreoretinal Surgery III
Session Date/Time: Friday 08/09/2017 | 08:00-09:30
Paper Time: 08:42
Venue: Room 111
First Author: : I.Nagel GERMANY
Co Author(s): : M. Schaumberger N. Arend H. Arda A. Kampik S. Priglinger A. Wolf
The main objective of this study is to compare the functional and anatomical outcome of patients presenting a bilateral rhegmatogenous retinal detachment (BRRD). Moreover, the predisposition for proliferative vitreoretinopathy (PVR) concerning the general incidence, the individual disease progression and the potential individual risk developing PVR after retinal surgery is observed.
The authors performed a retrospective study of 101 patients (202 eyes) who were operated for bilateral retinal detachment at the eye clinic of the Ludwig-Maximilians-University in Munich from 1994 to 2015. Minimum follow-up was one month.
All Patients undergoing surgery for retinal detachment in both eyes at the Ludwig-Maximilians-University between 1994 and 2015 were included in this study. Exclusion criteria were exudative or tractional retinal detachment as well as known systemic or ocular risk-factors for PVR (such as diabetic retinopathy, uveitis or ROP). The statistical analysis of the collected data was executed by using non-parametric tests (Chi-squared test, Fisher’s exact test) for comparing binary variables. Correlation of factors was performed with t-test or Mann-Whitney-U test. For detecting influencing factors to PVR linear and logistic regression models were used. The best-corrected visual acuity measured by Snellen chart was transformed into the Logarithm of the Minimum Angle of Resolution (logMAR). If a patient presented with simultaneous rhegmatogenous retinal detachment on both eyes at his first clinical presentation, the eye with a longer period of symptoms and a larger extent of retinal detachment was coded as the primarily affected eye.
The population presented typical predictors of retinal detachments: 81% male patients, average age of 56 years, 55% pseudophakia, 91% myopia. The consecutively affected eye (CE) was more likely having a better final visual outcome than the primarily affected eye (PE). The CE was presented averagely earlier after experiencing symptoms. It presented preoperatively a better visual acuity, fewer cases of macula-off status, lesser dimensions of the retinal detachment. This resulted in a shorter time of postoperative clinical care, fewer postoperative complications and lesser need of subsequent operations. The first surgical treatment, either scleral buckling (27%) or pars-plana-vitrectomy (73%), was initially anatomically successful in 100%. However, in longer follow-up, 38% of the patients needed additional surgery. In the final follow-up 98% of the patients presented a successful retinal attachment. A PVR was overall diagnosed in 76 eyes (38%, 47 (23%) with preoperative PVR diagnosis). A preoperative macula-off status, a clinical diagnosed atrophic retinal detachment and larger dimensions of the retinal detachment predisposed for the development of a PVR. If one eye developed a PVR, the second eye had an increased relative risk of 2,38 (odds ratio 3,58) to develop a PVR as well.
The authors were able to confirm the basic trend of smaller studies that mainly male patients suffer from a BRRD and the CE is more likely to have a better visual outcome than the PE in the biggest inquiry so far. The choice of the two surgical methods neither had a different impact on the healing process nor significant influence on the final visual outcome. The favored occurrence of PVR at the second eye after the fellow eye being affected could significantly be determined and leads to the question if there are any systemic predispositions for PVR.