Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study

Abstract

Background Rhegmatogenous retinal detachment (RRD) is a common, potentially blinding ocular pathology that is considered a surgical emergency. Macular involvement has been identified as a major negative prognostic indicator for visual recovery after RRD correction. It is not currently clear whether early intervention improves visual outcomes, and in practice, there are potential disadvantages to performing early surgery for fovea-involving RRD. Such disadvantages include inadequate assessment of coexisting comorbidities, increased rate of complications related to poorly trained staff or tired surgeons, and anesthetic risk. Methods A single-center, retrospective, cohort study of patients who underwent repair of macula-involving rhegmatogenous retinal detachment at the University of Virginia was performed. Variables collected included patient demographics, ocular history, clinical characteristics, and post-operative complications. Patients were excluded if they had a history of congenital or acquired pathology with an effect on visual function, bilateral or repeat rhegmatogenous detachment, age less than 18 years, follow up duration less than 6 months, or if they were repaired using scleral buckle, pneumatic retinopexy, 25- or 27-gauge pars plana vitrectomy, or any combination of these techniques. A multivariate regression model was used to compare overall outcomes such as post-operative visual acuity, intra-ocular pressure, retina attachment status, and complications among patients of differing timing of surgical repair. These analyses were adjusted for clinical factors known or considered to be associated with worse prognosis in rhegmatogenous retinal detachment. Results A total of 104 patients undergoing 23-gauge vitrectomy for repair of macula involving rhegmatogenous retinal detachments were included in this study with mean follow up period 17.9 ± 14.1 months. Early surgical repair (< 48 h) was pursued in 26 patients, moderately delayed surgical repair (3–7 days), was performed in 29 patients and late surgical repair (> 7 days) in 49 patients. Our analysis showed no difference in post-operative visual acuity between patients with detachments undergoing early versus moderately delayed repair of RRD. However, mean visual acuity differed between patients undergoing early versus late repair at 3, 6, and 12 months. No significant difference was observed in post-operative complications between the three surgical timepoints including cataract formation, development of glaucoma and re-detachment rate. Use of 360 laser was found to be protective against re-detachment overall (OR 6.70 95% CI 1.93–23.2). Conclusions These findings indicate that a moderate delay of 3–7 days from symptom onset for repair of macula-involving retinal detachment may be a safe approach as there are no differences in terms of visual acuity or post-operative complications compared to early repair within 48 h. Delaying surgery for > 7 days however is not recommended due to the loss of recovery of visual acuity observed in this study. Use of 360 laser may prevent risk of re-detachment after primary repair.

Kamuvudine-9 Protects Retinal Structure and Function in a Novel Model of Experimental Rhegmatogenous Retinal Detachment

“…By injecting a lower than typical concentration of CMC, which resembles the gelatinous texture and concentration of human vitreous humor, 38 we achieved a model in which spontaneous retinal reattachment occurs over 5 to 10 days of RRD, which approximates the time course of RRD in the standard-of-care clinical setting. 39 , 40 By self-reattaching, our model avoids reattachment procedures that would be technically complex and likely trauma inducing in the mouse eye. More important, reattachment of the retina facilitates electrophysiologic evaluation and clinically relevant assessments of functional outcomes in RRD.…”

Risk factors of post-operative optic nerve injury after vitrectomy: a systematic review

“…Bias due to confounding was reported in four studies. Demographic data (e.g., age, gender) were different between groups in study conducted by Speide, et al, 6 Elghawy et al, 8 and Moharram et al 10 The confounding factor that may affect study outcome was type of gas used in the study conducted by Rohrig, et al 16 Selection bias was seen in Spaide et al 6 due to no clear explanation regarding eligibility criteria for patient selection. The risk of bias in observational studies is shown in Figure 4 and Figure 5.…”

“…However, this study reported no significant difference regarding postoperative complications among the groups including the development of glaucoma (p = 0.52). 8 Nikolaenko et al (2019) reported the effect of tamponade type used in vitrectomy for vitreomacular traction syndrome on retinal and optic nerve functional activity. Electrophysiological testing was performed to assess the functional activity of retina and optic nerve.…”