Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study

Abstract

Introduction To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD). Methods A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery. Results There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C2F6 tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10–25%), and 10.1% are at high risk (>25%) of failure. Conclusions Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.

Routine use of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment

“…Older patients may have problems maintaining the required post-operative position, moreover they have an increased risk of forming PVR and weaker adhesion forces between the retina and the pigment epithelium. 24 Macular status could also play a role in the success rate, acting as an independent risk factor probably resulted of an older retinal detachment or on a weaker pigment epithelium. 24 Both the suggested risk factors are well known predictors of surgical failure, whatever technique is performed to repair the retina, and should influence our surgical choices.…”

“…24 Macular status could also play a role in the success rate, acting as an independent risk factor probably resulted of an older retinal detachment or on a weaker pigment epithelium. 24 Both the suggested risk factors are well known predictors of surgical failure, whatever technique is performed to repair the retina, and should influence our surgical choices. Based on our data, we should not claim to avoid air or use long lasting gases in those cases, but we suggest to keep particular attention and be aware of the more complicated cases.…”

“…According to the recent publication of Yorston et al, based on the multivariate modelling to compare SF6 and C2F6, C2F6 seems to be associated with a lower failure rate. 24 It should note that Yorston et al do not compare air with other gasses and collect data from different surgeons using different techniques.…”

“…[25][26][27] We think that cryotherapy is avoidable because it is believed to weaken the adhesive force during the first week because of local inflammation and edema, until it gradually strengthens to the same as laser levels. 24 Based on this evidence, we assume that the permanence of the air bubble in the vitreous cavity is enough to ensure the adherence of the retina to the retinal pigment epithelium.…”

Expansile gas kinetics for pneumatic retinopexy

“…Several fluorinated gases namely sulphur hexafluoride (SF6), hexafluoroethane (C2F6) and perfluoropropane (C3F8) are commonly used in treating vitreoretinal conditions, including vitrectomy for rhegmatogenous retinal detachment (RRD). 1 These gases were usually diluted to achieve isovolumetric concentrations in vitrectomy. In contrast, pure undiluted 100% concentrations are used due to their expansile nature in pneumatic retinopexy (PnR) to treat RRD and in pneumatic displacement to treat submacular haemorrhage.…”