RRD characteristics and visual outcomes

September 1, 2013

In this article, Mr Dogramaci highlights a recent study in which he and his colleagues examined the characteristics of RRD and the relationship these characteristics have on visual outcome.

The study

"Data from all patients attending a single author's (THW) vitreoretinal surgery service were prospectively entered into an electronic patient record (VITREOR, Microsoft Access, available with the book 'Vitreoretinal Surgery', published by Springer)," said Mr Dogramaci. "This electronic patient record requires recording of retinal detachment characteristics and digital drawings of the RRD, as well enabling the recording of postoperative outcomes; it is therefore a valuable tool for audit and clinical governance."

Mr Dogramaci explained that in patients, who developed bilateral RRD, the team only included the first eye in the study. Exclusion criteria also included, patients under 40 years of age (to avoid the influence of RRD from young myopes with atrophic holes and vitreous attached), or with aphakia, anterior chamber lens implant, giant retinal tear, retinal dialysis, macular hole-related RRD, retinoschisis-related RRD and dislocated lens nucleus during cataract surgery.

Retinal drawing

Any break present in any of the four quadrants was recorded. "The presence of inferior breaks were recorded, specifically noting their location in o'clock hours and whether they were in flat or detached retina. Inferior breaks can present particular challenges in surgical management, as compared with breaks elsewhere," Mr Dogramaci stressed.

Success

Success was defined in three categories at final follow-up:

1. Primary success with a fully attached retina without intraocular tamponade with one planned procedure (excluding oil removal) or two procedures if a planned delayed retinectomy was performed for PVR.

2. Secondary success when a fully flat retina even with silicone oil in situ was achieved outside those parameters described in 1.

3. Final failure with any area of retinal detachment at final follow-up.

"For most of the statistical comparisons, category 1 (primary success) have been compared to a combination of both 2 and 3 (primary failure). The primary outcome measure was the achievement of 6/9 vision (LogMAR 0.18) or better," continued Mr Dogramaci. "To determine the effect of duration of visual loss on visual recovery for patients with and without evidence of a clinically detached fovea (fovea off), patients with primary success of surgery and no PVR were further analysed."

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