Failure in retinal detachment surgery.

Abstract

Many modern series showing the results of the treatment of retinal detachment report high success rates (Custodis, I965; Davis, I965; Jesberg, I965; Hagler, I965; Schepens, i965; Kreiger, Hodgkinson, Frederick, and Smith, 1971). The object of this report is to focus attention on anatomical failure in retinal detachment surgery in an attempt to highlight the important preoperative, operative, and postoperative factors that can contribute to failure, and as a result ofthese findings to suggest means by which the incidence of failure may be reduced.In this series failure has been defined as either incomplete flattening of the retina after surgery, or re-detachment within a period of 6 months. Material and methodsIn this series only cases which have been treated exclusively by the unit have been included. This is because it was sometimes difficult to be sure of the factors responsible for failure in cases that had been operated upon elsewhere as it was not possible in such cases to observe either the preoperative state or the operation itself. Those which received prophylaxis only have not been included.There were 452 cases treated by the Unit between I967 and I972. The minimum follow-up period was 6 months. Cases were operated upon by either a Resident or a post-graduate Surgeon.Although there was sometimes divergence of views amongst us about the surgical treatment of some cases, in general the techniques employed were similar. Thus, for local procedures, episcleral silastic sponge implants buckled over full-thickness sclera were used, and for encirclement procedures, episcleral silicone rubber bands. In all cases cryotherapy was employed.The data on the failed cases in this study were compared to those obtained from a study of 0OO randomly selected successful cases ranging over the same period of time. ResultsOf the 452 cases, I I4 (25 per cent.) needed further surgery after the first operation. It was possible to re-attach 6I of these (a further 13 per cent.), but 53 cases (12 per cent.) were complete failures. Thus the overall success rate in this series was 88 per cent. (Table I). Of the I I4 cases, five were successfully re-attached after the first operation but re-detached within 6 months. PREOPERATIVE FACTORSThe factors that were found to be of particular significance (P < o .os) are set out in Table II. The term "uncertain holes" refers to cases in which it was not possible to be sure of the exact location of some or all of the retinal holes. The depth of subretinal fluid was roughly estimated by clinical examination as the depth of the subretinal fluid beneath the

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes

“…Early failures generally result from incomplete closure of breaks at primary surgery or missed primary breaks. 13,14 The fact that missed breaks are significant implies that successful management of retinal detachment requires good surgical skills, careful case selection and meticulous examination of the patient prior to surgery, in order that all retinal breaks and other relevant retinal pathology be identified and managed appropriately. 15 The low rates of surgery performed by non-specialists, possibly reflecting in part low numbers of patients presenting to them with retinal detachments, may not be sufficient to maintain such clinical and surgical skills thereby contributing to higher failure rates.…”

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. I. Sample and methods

“…[4][5][6][7][8][9][10][11][12][13][14] The minimum acceptable standards that the steering committee felt should be achieved are presented in Table 1.…”

Visual recovery after macula-off retinal detachment

“…[1][2][3][4][5][6][7][8][9] Despite this high level of anatomic success, visual results remain compromised mainly because of permanent functional damage once the macula becomes detached. 10 The most important predictor of visual recovery after retinal detachment surgery is preoperative visual acuity.…”