Final Anatomical Success Rate Research Articles

Results of primary retinal reattachment surgery: a prospective audit.

To define the current success rate of primary retinal detachment repair at one centre. One hundred and fifty-three consecutive patients undergoing surgery for primary retinal detachments over a 6 month period were studied prospectively. Data sheets were completed immediately after surgery and at final follow-up. One hundred and twenty-seven patients completed 6 months of follow-up. Follow-up data on the remainder were obtained from the referring unit or directly from the patients by telephone. The term primary success was used to describe persisting retinal reattachment after a single operation. Multiple logistic regression was carried out to establish factors associated with failure. One hundred and twenty-three patients (80%) had persisting retinal reattachment after a single procedure. Of the 30 patients who required further surgery, in 5 the retina remained detached at final follow-up. The final anatomical success rate was 97%. New or missed breaks were the major causes of failure of primary surgery. Failure of primary surgery was associated with the presence of highly elevated breaks (beta = 0.11, p = 0.03). No other pre-operative factors appeared to predict failure to reattach the retina. Comparison of these results with those of a previous audit carried out at this hospital 23 years ago suggests little improvement in the success rate of primary surgery (75% vs 80%). The improvement in final retinal reattachment has been rather greater (from 88% to 97%). The major impact of recent technical advances in retinal reattachment surgery has been on the success rate of reoperations after failed primary surgery.

Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment.

Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling. A retrospective study of 53 patients with a follow-up of 6-45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better. Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11% (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53). With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.

Results of surgical treatment of recent-onset full-thickness idiopathic macular holes.

To investigate whether the visual prognosis after macular hole surgery was different between recent and older holes and to evaluate preoperative characteristics and variations in surgical technique that may influence outcome. The medical charts of all our patients who underwent surgery for a full-thickness macular hole were retrospectively reviewed. Forty-eight eyes of 48 patients in the "early" group (symptoms < or = 6 months), and 20 eyes of 19 patients in the "late" group (symptoms > 6 months). Vitrectomy, separation of the posterior hyaloid, gas tamponade, and instructions to be face down for 1 week. Most patients had epiretinal membrane dissection. The early and late groups were compared regarding anatomic and visual outcomes. In the early group we evaluated the effect on outcome of the stage of the hole, intraocular tamponade, membrane dissection, and travel distance. Median postoperative visual acuity in the early group was 20/40 at 3, 6, and 12 months. Fifteen (56%) of 27 patients gained at least three lines of vision at 12 months. Anatomic success was seen with one operation in 75% (36/48), and with two operations in 87.5% (42/48). Stage 2 holes had a final anatomic success rate of 94.4%. Of respondents to an informal survey, 63.4% (26/41) believed that vision was greatly improved, and 70.3% (26/37) said that they would definitely choose surgery again. In the late group, median postoperative visual acuity was 20/100 at 6 months, compared with 20/142 preoperatively. Closure of the hole with one operation was seen in 60% (12/20) of the patients in the late group. Surgery in patients with recent macular holes has a better prognosis for visual rehabilitation than with older holes and appears to be considered beneficial by most patients.

Serous choroidal detachment after retinal detachment surgery.

In a prospective evaluation of 154 consecutive retinal detachment procedures, the incidence of choroidal detachment was 39.6%. The age of the patient, drainage of subretinal fluid, and vortex compression by the explant seem to be the most important correlative factors. Scleral explants up to one quadrant in circumferential length produced a minimal incidence (7.7%) of choroidal detachment. Posterior positioning of the explant also affected the incidence of choroidal detachment. After follow-up, ranging from six to 48 months, postoperative visual acuity was recorded for "macula-on" as well as "macula-off" retinal detachments. In the macula-on group, 78.6% of the patients with choroidal detachment retained a visual acuity of 20/50 or better compared with 82.8% of the patients without choroidal detachment. In the macula-off group, 43.2% of the patients with choroidal detachment achieved a visual acuity of 20/50 or better compared with 55.1% of the patients without choroidal detachment. The final anatomic success rate was 86.5% for eyes with choroidal detachment and 92.3% for eyes without choroidal detachment.