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 Table of Contents    
ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 179-182  

Outcome of rhegmatogenous retinal detachment repair: Experience of a tertiary center in Oman


Department of Ophthalmology, Sultan Qaboos University Hospital, Sultanate of Oman, Muscat, Oman

Date of Web Publication30-Nov-2013

Correspondence Address:
Ahmed S Al-Hinai
Department of Ophthalmology, Sultan Qaboos University Hospital, Sultanate of Oman, Muscat, Al Khod -23
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.122274

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   Abstract 

Aim: To study the outcome of repair of rhegmatogenous retinal detachment (RRD) in a tertiary center.
Design: Retrospective study.
Materials and Methods: Review of electronic medical records within a period of 29 months of consecutive patients who underwent surgical repair for RRD in Sultan Qaboos University Hospital (SQUH).
Results: We included 33 consecutive patients (36 eyes). Males constituted 70% of them. The average age was 47 years. Seven eyes out of the 36 had macula-on RRD at presentation. The primary success rate with a single procedure was 86%. However, redetachment occurred in five eyes (14%). Visual acuity was either same as preoperative or better in 81% of the eyes. Giant retinal tear was found in three eyes (8%). The average follow-up period for all patients was 10.25 months (range: 3-25 months).
Conclusion: Rhegmatogenous RD is not uncommon disorder. It occurs more frequently in males. However, it has a good prognosis if an intervention was performed in early stages.

Keywords: Detachment, vitrectomy, outcome


How to cite this article:
Al-Hinai AS, Al-Abri MS. Outcome of rhegmatogenous retinal detachment repair: Experience of a tertiary center in Oman. Oman J Ophthalmol 2013;6:179-82

How to cite this URL:
Al-Hinai AS, Al-Abri MS. Outcome of rhegmatogenous retinal detachment repair: Experience of a tertiary center in Oman. Oman J Ophthalmol [serial online] 2013 [cited 2019 Dec 14];6:179-82. Available from: http://www.ojoonline.org/text.asp?2013/6/3/179/122274


   Introduction Top


Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from underneath layer of retinal pigment epithelium (RPE) in presence of at least one retinal break. In 1904, retinal detachment (RD) was declared as an untreatable disorder at the International Congress in Paris. [1] Gonin, who found out that retinal breaks are the primary cause of RRD, described in 1920 for the first time successful treatment for RRD by localizing the tears, draining subretinal fluid using cautery and bed rest. [2] His technique had 50% success rate. Scleral buckle technique was introduced in 1951 by Charles L. Schepens with a success rate close to 90%. [1] In 1970, pars plana vitrectomy (PPV) was introduced by Robert Machemer as an alternative treatment for RRD. [1] Most recently in 1986, Hilton and Grizzard introduced pneumatic retinopexy as a treatment for RRD as an outpatient procedure. [3]

Overall, current treatment of RRD with different surgical techniques has anatomical success rate of more than 90%. [4],[5] Combined techniques of scleral buckle and PPV are commonly used by many vitreoretinal surgeons. This technique is used especially in complicated cases such as RRD associated with proliferative vitreoretinopathy (PVR), giant retinal tears and/or inferior retinal breaks.

Visual outcome after RD repair is not as high as the anatomic success rate especially in cases of macula-off RRD, where macula is detached. Many factors influence the visual outcome in these cases such as preoperative visual acuity, duration of detachment, age of patients, structural macular changes, and type of surgical technique. [6],[7],[8],[9] In this study, we studied outcome of RRD repair in consecutive patients.


   Materials and Methods Top


A retrospective electronic medical record analysis was carried out for patients with diagnosis of RRD. The covered period of this study was from November 2009 to March 2012 (29 months). All patients were operated at the Sultan Qaboos University Hospital (SQUH) by two vitreoretinal surgeons. SQUH is one of the three tertiary governmental hospitals in Oman that has been recently equipped for vitreoretinal surgeries. All consecutive patients with RRD were included in the study. Patients with follow-up period of less than three months were excluded.

Preoperative clinical findings were obtained from the assessment notes. This included age and gender of the patients, phakic status, and macula status. Types of surgical techniques were also included. Postoperative outcome and complications were obtained, too.


   Results Top


A total of 33 patients (36 eyes) met the inclusion criteria. Male patients constituted 70% of all patients. [Table 1] gives more demographic data.
Table 1: Patient demography

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RRD was seen more common in older patients, see [Figure 1]. RRD due to giant retinal tears occurred in three eyes (8%). Two of them were phakic and the third was aphakic. The average age of those patients was 36 years (24-50 years).
Figure 1: Patients with rhegmatogenous retinal detachment in different age groups

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The total number of procedures that were performed to treat RRD in all eyes was 44. However, reattachment of retina after one surgery (i.e., primary success rate) was achieved in 31 eyes (86%). In five patients, five (14%) out of the 36 eyes required more than one procedure to achieve the retinal reattachment. Four eyes (11%) required two procedures and only one eye (3%) required three procedures to attach the retina. Four out of the five patients with redetachment were less than 32 years of age, [Figure 2]. In addition, PVR grade C (PVR-C) developed in four eyes of four patients with redetachment. Three out of the four patients with PVR-C were less than 24 years of age. All eyes with redetachment has had attached retina as a final result after more than one procedure.
Figure 2: Right eye of a 21-year old girl with redetached retina

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Different surgical techniques were used to repair RDs in our patients. The chart in [Figure 3] shows all types of performed procedures. Out of the 44 procedures, PPV with 23-guage system was performed in 12 cases (28%) and with 20-gauge system in 31 cases (72%). On other hand, silicone oil tamponade was used in 26 cases (60%) and 17 cases (40%) were done with a gas as a tamponade. Scleral buckle as a single procedure was performed only in one eye. Choice of anesthesia type was determined based on several factors including the length and type of the procedure, patient request, and surgeon preference. Out of the 44 procedures, general anesthesia was used in 32 (73%) procedures and local anesthesia was used in 12 procedures (27%). One of the main reasons for using general anesthesia was because of the sclera buckle procedure, which is painful.
Figure 3: The different surgical techniques used in RRD patients. SB: Scleral buckle; SB+vit: Scleral buckle and vitrectomy; SB+vit+phaco: Scleral Buckle and vitrectomy and phacoemulsifi cation; phaco+vit: phacoemulsifi cation and vitrectomy

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Postoperative visual acuity outcome is represented in [Figure 4]. Worsened visual acuity was noticed in seven eyes (seven patients, six males and one female). Their average age was 48 years. Four of them presented with macula-off RRD and the other three with macula-on RRD. The three eyes with macula-on RRD and with worsened postoperative visual acuity developed postoperative cataract, epiretinal membrane, and a macular hole. The duration of the RD was more than 4 weeks in six patients. Out of those seven patients, four were phakic, two aphakic, and one pseudophakic. The presumed reasons of reduced postoperative visual acuity are summarized in [Table 2].
Figure 4: Visual outcome postoperatively in all eyes

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Table 2: Causes of post-operative visual reduction

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   Discussion Top


To the best of our knowledge, this study is the first study done in our institute to find out outcome of RRD repair. We included 33 consecutive patients. Males constituted 70% of the cases. Male sex as a risk factor for development of RD was also mentioned in the literature. [9],[10],[11],[12]

There was no significant difference between right and left eyes in terms of incidence of RRD (58 vs 42%, respectively). Patients with macula-off RD represented 81% of all patients. This high figure could be explained by some reasons like unawareness of visual symptoms with patients and rapid progression of RRD.

More than half of the patients (56%) were phakic and rest were either pseudophakic (33%) or aphakic (11%). This finding is similar to a previous study in literature, in which a population of patients of RRD was studied. [13] In that study, phakic eyes constituted 55%, pseudophakic 35%, and aphakic 10%. However, it is known that aphakia and pseudophakia status are risk factors for development of RRD. [14],[15],[16]

Retinal tears in RRD are not detected prior to the repair in some patients. They can be missed in up to 22.5% of the cases. [11] The main factors that lead to inability to find out these tears are cataract, capsular opacity, small pupil, vitreous hemorrhage, anterior location, and small size of the tears. In our patients, the tears were not detected in 12 eyes (33% of total). Seven of them were phakic, one aphakic, and four were pseudophakic. Therefore, cataract was an important cause of missing retinal tears in those cases. Clinical examination with the help of B-scan ultrasonography was an essential tool to diagnose RRD in those cases. Five of these 12 eyes had scleral buckle implantation in addition to the PPV.

Age is considered as a risk factor for RRD. [17] Our results revealed that two-thirds of the patients were older than 40 years of age. This is not surprising, since elderly people are at risk to develop posterior vitreous detachment, and to have intraocular surgeries for any other reasons, especially cataract extraction. There was one patient who was a child of 8-year-old of age. She was with congenital peripheral retinal anomalies which lead to development of RRD. She had a strong family history of RRD. Her retina was reattached after three surgeries (one sclera buckle and two vitrectomies).

Our results showed that the primary success rate was 86%. A second surgery to repair the same RD was required in 11% of the eyes. Only one eye (3%) required a third intervention to reattach the retina. All eyes had attached retina as a final result. It was noticed that young patients are at risk to develop PVR as three out of four patients with PVR-C were less than 24 years of age. Young age as a risk factor to develop PVR was also observed by other studies. [18],[19]

Stabilization or improvement in visual acuity is the primary goal after repair of RRD. In our group of patients, 81% of all eyes had same or better visual acuity after surgery. From all eyes, 62% had improvement in vision. Seven eyes had visual deterioration after surgery, and males were the majority of those patients. It was also noticed that postoperative visual acuity did not improve after another intervention in patients who developed epiretinal membrane (ERM), macular hole, and PVR. This might be related to the permanent damage to foveal photoreceptors from longstanding RD itself or from the secondary pathologies that developed post-operatively such as ERM and macular hole. Cataract, which can develop after vitrectomy, can reduce visual acuity. However, visual improvement after cataract extraction in these patients is expected.


   Conclusion Top


In general, anatomical and functional prognosis for patients with RRD is promising in the last few decades, especially after the introduction of vitrectomy in 1970s with subsequent revolution in the instrumentation, microsurgical, and illumination techniques required for such delicate intraocular surgeries. This study has added some insight on the outcome of RRD repair in one center in Oman. We believe, more work needs to be done to include other centers in the country in order to draw robust conclusions and recommendations for future strategic planning. However, we can conclude that the outcome of RRD repair in this study is similar to what has been mentioned in the literature.

 
   References Top

1.Sodhi A, Leung LS, Do DV, Gower EW, Schein OD, Handa JT. Recent trends in the management of rhegmatogenous retinal detachment. Surv Ophthalmol 2008;53:50-67.  Back to cited text no. 1
    
2.Scott JD. Future perspectives in primary retinal detachment repair. Eye (Lond) 2002;16:349-52.  Back to cited text no. 2
    
3.Hilton GF, Grizzard WS. Pneumatic retinopexy. A two-step outpatient operation without conjunctival incision. Ophthalmology 1986;93:626-41.  Back to cited text no. 3
    
4.Abouzeid H, Wolfensberger TJ. Macular recovery after retinal detachment. Acta Ophthalmol Scand 2006;84:597-605.  Back to cited text no. 4
    
5.Weichel ED, Martidis A, Fineman MS, McNamara JA, Park CH, Vander JF, et al. Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology 2006;113:2033-40.  Back to cited text no. 5
    
6.Lecleire-Collet A, Muraine M, Menard JF, Brasseur G. Predictive visual outcome after macula-off retinal detachment surgery using optical coherence tomography. Retina 2005;25:44-53.  Back to cited text no. 6
    
7.Butler TK, Kiel AW, Orr GM. Anatomical and visual outcome of retinal detachment surgery in children. Br J Ophthalmol 2001;85:1437-9.  Back to cited text no. 7
    
8.Yeung L, Yang KJ, Chen TL, Wang NK, Chen YP, Ku WC, et al. Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment. Acta Ophthalmol 2008;86:165-9.  Back to cited text no. 8
    
9.Ross W, Lavina A, Russell M, Maberley D. The correlation between height of macular detachment and visual outcome in macula-off retinal detachments of < or =7 days' duration. Ophthalmology 2005;112:1213-7.  Back to cited text no. 9
    
10.Sheu SJ, Ger LP, Chen JF. Male sex as a risk factor for pseudophakic retinal detachment after cataract extraction in Taiwanese adults. Ophthalmology 2007;114:1898-903.  Back to cited text no. 10
    
11.Salicone A, Smiddy WE, Venkatraman A, Feuer W. Management of retinal detachment when no break is found. Ophthalmology 2006;113:398-403.  Back to cited text no. 11
    
12.Chan CK, Lin SG, Nuthi AS, Salib DM. Pneumatic retinopexy for the repair of retinal detachments: A comprehensive review (1986−2007). Surv Ophthalmol 2008;53:443-78.  Back to cited text no. 12
    
13.Steel D, Fraser S. Retinal detachment. Clin Evid (Online) 2008;2008.  Back to cited text no. 13
    
14.Tseng W, Cortez RT, Ramirez G, Stinnett S, Jaffe GJ. Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. Am J Ophthalmol 2004;137:1105-15.  Back to cited text no. 14
    
15.Tielsch JM, Legro MW, Cassard SD, Schein OD, Javitt JC, Singer AE, et al. Risk factors for retinal detachment after cataract surgery. A population-based case-control study. Ophthalmology 1996;103:1537-45.  Back to cited text no. 15
    
16.Tuft SJ, Minassian D, Sullivan P. Risk factors for retinal detachment after cataract surgery: A case-control study. Ophthalmology 2006;113:650-6.  Back to cited text no. 16
    
17.Törnquist R, Stenkula S, Törnquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971 − 1981. I. Epidemiology. Acta Ophthalmol (Copenh) 1987;65:213-22.  Back to cited text no. 17
    
18.Pastor JC, de la Rúa ER, Martín F. Proliferative vitreoretinopathy: Risk factors and pathobiology. Prog Retin Eye Res 2002;21:127-44.  Back to cited text no. 18
    
19.Malbran E, Dodds RA, Hulsbus R, Charles DE, Buonsanti JL, Adrogué E. Retinal break type and proliferative vitreoretinopathy in nontraumatic retinal detachment. Graefes Arch Clin Exp Ophthalmol 1990;228:423-5.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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