Purpose: To retrospectively evaluate unsuccessful factors for rhegmatogenous retinal detachment (RRD) from surgical outcomes.
Subjects and methods: The study included 412 eyes of 404 patients〔278 men and 126 women, mean age 52.6 years, including 12 eyes with Grade C or higher proliferative vitreoretinopathy (PVR)〕who underwent initial surgery for RRD between April 2020 and March 2021. Macular hole retinal detachment and RRD associated with ocular perforating injuries were excluded. Patients were classified into two groups as follows: the primary success group (group A; n=386 eyes) and failure group (group B; n=26 eyes), and the relationships between preoperative factors (visual acuity, type of retinal breaks, and area of detachment, among others), surgical procedures, and surgical outcomes were investigated.
Results: The surgical procedures included pars plana vitrectomy, scleral buckling, and combined surgery in 316, 79, and 17 eyes, respectively. The primary success rate was 93.7% (RRD 94.2%, PVR 75.0%) and the final success rate was 98.8%. Regarding preoperative unsuccessful factors, the mean preoperative logarithmic minimum angle of resolution (logMAR) visual acuity was significantly poorer in group B than in group A (0.44 and 0.72 in groups A and B, respectively) (p=0.049). Incidences of retinal breaks inferior to the original, wide detached quadrants, and PVR were significantly higher in group B (p<0.01, respectively). A subgroup analysis of the inferior retinal breaks indicated that the success rate of pars plana vitrectomy for RRD with inferior atrophic hole was significantly worse than that with flap tears (p=0.018), resulting in a poorer primary success rate than after scleral buckling (p=0.026). The number of retinal breaks, incidences of high myopia, macular detachment, and surgical procedures showed no significant intergroup difference. Reoperation was performed on 26 eyes in the group B. The reasons for reoperation were suture failure of the original retinal break in 42.3%, PVR in 42.3%, and a new retinal break in 15.4%. Visual acuity at 6 months after the final surgery was significantly better in group A.
Conclusion: Unsuccessful factors for RRD surgery include poor preoperative vision, inferior break, wide detached quadrants, and PVR, and countermeasures should be considered for cases with these factors.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127:85-91,2023.