Abstract
To describe the 25-year surgical trends, long-term outcomes and risk factors affecting the outcomes of giant retinal tear-related rhegmatogenous retinal detachments (GRT-RRD). Patients’ demographics, pre-operative characteristics, risk factors, operative procedures and post-operative outcomes were collected and divided into three groups – Group A: 1991 to 2015 (overall); Group B: 1991 to 2005, and Group C: 2006 to 2015. Functional and anatomical successes were monitored over a 5-year period. Multivariate logistic regression analysis was performed to identify the risk factors related to functional and anatomical success.127 eyes of 127 patients were included in the study. At 5th year, 69.4% patients had visual acuity (VA) < logMAR 1.0 with 87.5% primary anatomical success rate. While the functional outcome remained the same between group B and C, there was an increase in the anatomical success from 89.7% to 100%, albeit not statistically significant. Patients with worse presenting VA, 150 degrees or more of giant retina tear, macula-detached status and presence of PVR were associated with VA of> logMAR 1.0 (all p < 0.05). The types of surgery (TPPV vs combined SB/TPPV), number of breaks, lens extraction and additional cryotherapy were not associated with the functional or anatomical success. In conclusion, the GRT-RRD functional and structural outcomes were comparable between 1991–2005 and 2006–2015, albeit a statistically insignificant improvement of anatomical outcome over the past 25 years. Worse presenting VA, 150 degrees or more of giant retinal tear, detached macula and presence of PVR were associated with poorer visual outcome.
Highlights
The surgical options for GRT repair include primarily trans pars plana vitrectomy (TPPV) with or without the combined use of an encirclage scleral buckle (SB) or primary scleral buckle
Lee et al reported an anatomical success rate of 85% and an improvement of visual acuity VA) of 20/40 or better in 40% after at least 6 months of follow-up[10], with all patients undergoing TPPV (100%) and additional SB performed for 70.3% for all giant retinal tear-related rhegmatogenous retinal detachments (GRT-RRD) patients
Ang et al reported a good outcome on primary TPPV for 62 GRT-RRD patients in UK, with laser retinopexy and silicone oil tamponade[2], with 94.7% anatomical success and 42.1% functional success (VA > 20/40 or better)
Summary
The surgical options for GRT repair include primarily trans pars plana vitrectomy (TPPV) with or without the combined use of an encirclage scleral buckle (SB) or primary scleral buckle (with segmental/encirclage SB) It is Characteristics Patient demographics Age, mean (SD) Gender, number (%) Male Female Race, number (%) Chinese Malay Indian Others Pre-operative characteristics LogMAR BCVA, mean (SD) >1.0 0.3 < x < = 1.0 −0.5, but < −6.0D) Non-myopic Lens status, number (%) Phakic Pseudophakic Aphakic Extent of GRT, number (%) 90 to
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