Surgical Audit for the Outcome of Primary Rhegmatogenous Retinal Detachment Repair in the Kingdom of Bahrain.

Abstract

The purpose of the study was to audit the primary and final success rate for primary rhegmatogenous retinal detachment (RRD) surgery performed between 2017 and 2022 at the Department of Ophthalmology in Salmanyia Medical Complex, the Kingdom of Bahrain. In addition, secondary outcomes for our study include assessments of risk factors for recurrence, final visual outcomes and complication rates. Prospective observational study showed data analysis of case series for 75 RRD patients operated during the study period. All patients who met the inclusion criteria were included in the study and evaluated by a specialized vitreoretinal surgeon before and after their operation. All patients were operated by the same surgeon (M.A) in the study period. Data collected from the hospital's electronic medical recording system (I-Seha) include macular state, pre- and postoperative best-corrected visual acuity, duration of symptoms, the presence of proliferative vitreoretinopathy (PVR), retinal breaks and their locations, any ocular comorbidities associated in the perioperative period such as increase in intraocular pressure or development of cataract, and operative notes related to the type of primary, secondary, and tertiary surgery if needed. A total number of 70 eyes from 70 patients with the majority of male patients (74.28%, n = 52) were included in the study. The mean age of the participants was 54.75 years (range: 11-91 years). Most of the patients 48.57% presented within 6 days of symptoms. Nearly 77.1% of the operated cases were macula off, whereas 22.85% were macula on. Thirty-six of the eyes (51.4%) had complex RRD with a combination of PVR (34.2%). Sixty-three of the eyes (51.4%) underwent standard 23G pars plana vitrectomy, while the combined surgery with a scleral buckle was performed on 9 eyes (12.8%). Five patients underwent pneumatic retinopexy and two patients had primary scleral buckles. Combined phacoemulsification with vitrectomy in selected cases was performed on 13 eyes (18.5%). Different tamponading agents were used 35 eyes (50%) silicon oil, 17 eyes (24%) C3F8, and 18 eyes (25%) SF6. The primary reattachment rate after one operation was 77.1% (54 eyes). The final reattachment rate following a second or third procedure was 95.7%. The mean postoperative visual acuity was 6/18 (range: 6/6 to hand motions). Thirty percent of the cohort of patients had a visual acuity of 6/12 or better. Sixteen out of the 70 eyes redetached (22.8%) and 10 of those eyes (62.5%) were classified as "complex" preoperatively which is thought to be a significant risk factor for failure. Our audit overall met international success rates despite the presence of some complex scenarios which required multiple surgical interventions. The primary use of gas or silicon oil did not influence reattachment rates but had a statistical significance when it came to final visual outcomes.