ANATOMICAL AND FUNCTIONAL OUTCOME FOLLOWING PRIMARY RETINAL RE-ATTACHMENT SURGERY IN PHAKIC AND PSEUDOPHAKIC RHEGMATOGENESIS RETINAL DETACHMENT

Authors

  • Asfandyar Asghar
  • Aziz ur Rehman
  • Waseem H Jafri
  • Yawar Zaman
  • Nasir Bhatti
  • Mazhar ul Hassan

Abstract

Background: Rhegmatogenous Retinal detachment (RRD) is relatively unusual in general population;annual incidence is 1:10,000. Objective of this study was to compare the anatomical and functionaloutcome of primary retinal re-attachment surgery in phakic and pseudophakic eyes. Methods: A caseseries comparative study was carried out at Al-Ibrahim Eye Hospital, Karachi from July 2008 to June2009. A total of 71 eyes of 69 patients either phakic (group-I) or pseudophakic (group-II) rhegmatogenousretinal detachment (RRD) with proliferative vitreoretinopathy (PVR) up to grade C-3 were included in thestudy. Eyes with RRD with PVR C-4 and above, corneal opacity and previous posterior segment surgerywere excluded. Pars plana vitrectomy (PPV) or scleral buckling procedure (SBP) was performed as aprimary re-attachment surgery. Patients were followed for at least 6 months. Anatomical (retinalreattachment) and functional outcome (best corrected visual acuity) was noted at each follow up. Results:Anatomical outcome (retinal reattachment) was similar in group-I (93.02%) and group-II (92.86%) eyes(p=0.88). Best corrected visual acuity (functional outcome) of 6/6‒6/18 was achieved in 46.5% in Group-Iand 10.7% in Group-II. Raised intraocular pressure (IOP) was observed as most common complication.Conclusion: Primary retinal re-attachment surgery either in phakic (group-I) or pseudophakic (group-II)eyes have similar anatomical outcome but functional outcome depends upon the status of macula at thetime of surgery and level of proliferative vitreoretinopathy (PVR).Keywords: Pars plana vitrectomy, Scleral buckling procedure, proliferative vitreoretinopathy

References

Haimann MH, Burton TC, Brown CK. Epidemiology of retinal

detachment. Arch Ophthalmol 1982;100:289‒92.

Javitt JC, Vitale S, Canner JK, Krakauer H, Mc Bean AM,

Sommer A. National outcomes of cataract extraction. I. Retinal

detachment after inpatient surgery. Ophthalmology

;98:895‒902.

Kratz RP, Mazzocco TR, Davidson B, Colvard DM. A

comparative analysis of anterior chamber, iris-supported,

capsule-fixated, and posterior chamber intraocular lenses

following cataract extraction by phacoemulsification.

Ophthalmology 1981;88:56‒8.

Halberstadt M, Brandenburg L, Sans N, Koerner-Stiefbold U,

Koerner F, Garweg JG. Analysis of risk factors for the outcome

of primary retinal reattachment surgery in phakic and

pseudophakic eyes. Klin Monbl Augenheilkd 2003;220:116‒21.

Bradford JD, Wilkinson CP, Fransen SR. Pseudophakic retinal

detachments. The relationships between retinal tears and the time

following cataract surgery at which they occur. Retina

;9:181‒6.

Lois N, Wong D. Pseudophakic retinal detachment. Surv

Ophthalmol 2003;48:467‒87.

Isernhagen RD, Wilkinson CP. Visual acuity after the repair of

pseudophakic retinal detachments involving the macula. Retina

;9:15‒21.

The classification of retinal detachment with proliferative

vitreoretinopathy. Ophthalmology 1983;90:121‒5.

Campo RV, Sipperley JO, Sneed SR, Park DW, Dugel PU,

Jacobsen J, et al. Pars plana vitrectomy without scleral buckle for

pseudophakic retinal detachments. Ophthalmology

;106:1811‒5.

Speicher MA, Fu AD, Martin JP, Fricken MA. Primary

vitrectomy alone for repair of retinal detachments following

cataract surgery. Retina 2000;20:459‒64.

Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary

pars plana vitrectomy versus scleral buckle surgery for the

treatment of pseudophakic retinal detachment: a randomized

clinical trial. Retina 2005;25:957‒64.

Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers

RD, Foerster MH. Scleral Buckling versus Primary Vitrectomy

in Rhegmatogenous Retinal Detachment Study Group. Scleral

buckling versus primary vitrectomy in rhegmatogenous retinal

detachment: a prospective randomized multicenter clinical study.

Ophthalmology 2007;114:2142‒54.

Al-Khairi AM, Al-Kahtani E, Kangave D, Abu El-Asrar AM.

Prognostic factors associated with outcomes after giant retinal

tear management using perfluorocarbon liquids. Eur J

Ophthalmol 2008;18:270‒7.

Pastor JC, Fernández I, Rodríguez de la Rúa E, Coco R,

Sanabria-Ruiz Colmenares MR, Sánchez-Chicharro D, et al.

Surgical outcomes for primary rhegmatogenous retinal

detachments in phakic and pseudophakic patients: the Retina 1

Project‒report 2. Br J Ophthalmol 2008;92:378‒82.

Rosman M, Wong TY, Ong SG, Ang CL. Retinal detachment in

Chinese, Malay and Indian residents in Singapore: a comparative

study on risk factors, clinical presentation and surgical outcomes.

Int Ophthalmol 2001;24:101‒6.

Halberstadt M, Chatterjee-Sanz N, Brandenberg L, KoernerStiefbold U, Koerner F, Garweg JG. Primary retinal reattachment

surgery: anatomical and functional outcome in phakic and

pseudophakic eyes. Eye (Lond) 2005;19:891‒8.

Acar N, Kapran Z, Altan T, Unver YB, Yurtsever S,

Kucuksumer Y. Primary 25-gauge sutureless vitrectomy with

oblique sclerotomies in pseudophakic retinal detachment. Retina

;28:1068‒74.

Nagasaki H, Shinagawa K, Mochizuki M. Risk factors for

proliferative vitreoretinopathy. Prog Retin Eye Res

;17:77‒98.

Hooymans JM, De Lavalette VW, Oey AG. Formation of

proliferative vitreo-retinopathy in primary rhegmatogenous

retinal detachment. Doc Ophthalmol 2000;100:39‒42.

Jun BY, Shin JP, Kim SY. Clinical characteristics and surgical

outcomes of pseudophakic and aphakic retinal detachments.

Korean J Ophthalmol 2004;18:58‒64.

Pournaras CJ, Kapetanios AD. Primary vitrectomy for

pseudophakic retinal detachment: a prospective non-randomized

study. Eur J Ophthalmol 2003;13:298‒306.

Tognetto D, Minutola D, Sanguinetti G, Ravalico G. Anatomical

and functional outcomes after heavy silicone oil tamponade in

vitreoretinal surgery for complicated retinal detachment: a pilot

study. Ophthalmology 2005;112:1574.

Kapetanios AD, Donati G, Pournaras CJ. [Idiopathic giant retinal

tears: treatment with vitrectomy and temporary silicone oil

tamponade]. J Fr Ophtalmol 2000;23:1001‒5.

Le Mer Y, Renard Y, Ameline B, Haut J. [Long-term results of

successful surgical treatment of retinal detachment by vitrectomy

and silicone oil injection. Effect of removal of the tamponade on

further complications]. J Fr Ophtalmol 1992;15:331‒6.

Martínez-Castillo V, Boixadera A, García-Arumí J. Pars plana

vitrectomy alone with diffuse illumination and vitreous dissection

to manage primary retinal detachment with unseen breaks. Arch

Ophthalmol 2009;127:1297‒304.

Published

2010-09-01