Dealing with rhegmatogenous retinal detachment in patients under 40 years old: a tertiary center results

Marques, João Heitor; Castro, Catarina; Malheiro, Luísa; Correia, Nuno; Pessoa, Bernardete; Beirão, João Melo; Meireles, Angelina; Ferreira, Natália

doi:10.1007/s10792-020-01597-w

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…In our study, PPV alone resulted in good anatomic success rates in these younger patients. While our overall SSS rate was 79% and higher than previously reported in the literature, it is skewed towards our oldest age group [ 4 , 19 ]. SSS rates were significantly higher in group 3 (92%) compared to groups 1 (50%) and 2 (64%), indicating that PPV is less likely to be a “one and done” repair method in younger patients.…”

Section: Discussioncontrasting

confidence: 70%

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

et al. 2023

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Background Scleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes. Methods Retrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal–Wallis tests for numeric covariates between age groups. Results Eyes were stratified by age: 15–24 (group 1, n = 10), 25–34 (group 2, n = 14), and 35–45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p < 0.001). Conclusion While the final reattachment rates were excellent in all groups, the higher rates of proliferative vitreoretinopathy and lower single surgery success rate in younger patients may suggest that primary pars plana vitrectomy may not be the optimal repair method in these age groups.

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Section: Discussioncontrasting

confidence: 70%

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

et al. 2023

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“…Also, eyes that did not achieve primary surgical success for whom final follow-up data including BCVA and reattachment rates were available likely had additional procedure(s). Only four studies which reported final success data specified that PPV was the preferred surgical modality for eyes requiring additional procedures, irrespective of initial assignment to SB alone or SB + PPV [29, 30, 35, 43].…”

Section: Discussionmentioning

confidence: 99%

“…Fig. S1) [16,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Eight (44.44%) studies explicitly excluded and/or did not have any baseline eyes with PVR grade C or worse, nine (50%) excluded eyes with a history of ocular trauma, seven (38.89%) excluded eyes with macular hole, and nine (50%) excluded eyes with previous vitreoretinal surgery.…”

Section: Baseline Demographic Characteristicsmentioning

confidence: 99%

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

et al. 2022

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Purpose: The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB+PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear. Methods: A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB+PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated. Results: Across 18 studies, 3912 SB and 3300 SB+PPV eyes were included. Final BCVA was non-significantly different between SB and SB+PPV (20/38 vs. 20/66 Snellen; WMD=–0.11 LogMAR; 95%CI [–0.29,0.07]; P=0.23). Primary reattachment rate was similar between procedures (P=0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR=1.03; 95%CI [1.00,1.06]; P=0.04). Compared to SB+PPV, SB alone had a significantly lower risk of postoperative macular edema (RR=0.69; 95%CI [0.47,1.00]; P=0.05) and cataract formation (RR=0.34; 95%CI [0.12,0.96]; P=0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB+PPV. Conclusions: There was no significant difference in final BCVA between SB+PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.

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“…8 9 Some studies have indicated that older age is associated with worse outcomes, 10 while others have shown younger patients have worse outcomes or that there is no difference between the two populations. [11][12][13] There have been few studies comparing outcomes of SB, PPV and PR in young patients given the relative rarity of primary RRDs in younger patients. Election of treatment options for young patients tend to ultimately revolve around surgeons' preference or facilities'availability.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

“…Given that ageing and PVD are major risk factors for retinal detachment, sample sizes for young (<50 years of age) patients are under-represented in these studies and the effect of age on RRD outcomes remains less clear 8 9. Some studies have indicated that older age is associated with worse outcomes,10 while others have shown younger patients have worse outcomes or that there is no difference between the two populations 11–13…”

Section: Introductionmentioning

confidence: 99%

Effect of surgical modality on visual outcomes for young patients with primary rhegmatogenous retinal detachments: a retrospective cohort study

et al. 2022

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ObjectiveTo examine outcomes of different surgical modalities for correcting primary rhegmatogenous retinal detachments in patients younger than 50 years of age.Methods and analysisA single-centre, retrospective, cohort study of 754 patients who underwent retinal surgery at the University of Virginia Hospital between 1 July 2012 and 1 July 2020 was conducted. Exclusion criteria were patients less than 18 or over 50 years of age, repeat detachments, second eyes of patients with bilateral detachments and follow-up less than 3 months. A multivariate regression model was used to compare overall outcomes in patients.Results86 patients met inclusion criteria and of those, 38 (44%) underwent vitrectomy, 22 (26%) underwent scleral buckling, 13 (15%) underwent pneumatic retinopexy and 13 (15%) underwent combined scleral buckle and vitrectomy repair. Comparison of eye-level parameters among the procedure groups shows difference with respect to macular involvement (p<0.05) but not regarding clock hour involvement or giant tear status (p>0.05). Preoperative visual acuity was superior in the scleral buckle group compared with vitrectomy (p<0.001). Mean postoperative visual acuity improved with all procedures and all repair procedures had comparable rates of complication. The mean overall anatomical success rate was 73% (n=63) and comparable among all modalities.ConclusionsVitrectomy, scleral buckle, pneumatic retinopexy or combined procedures are viable repair options for rhegmatogenous retinal detachments in patients younger than 50 years of age. Selection of the repair modality should be guided on baseline clinical features of the patient and detachment.

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Dealing with rhegmatogenous retinal detachment in patients under 40 years old: a tertiary center results

Cited by 7 publications

References 24 publications

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

Effect of surgical modality on visual outcomes for young patients with primary rhegmatogenous retinal detachments: a retrospective cohort study

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