Anatomic outcomes after retinal detachment surgery in patients with retinal detachment associated with choroidal detachment
Barrett, Jake Adams
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PURPOSE: To investigate relationships between preoperative and intraoperative characteristics with outcome variables in patients suffering from primary rhegmatogenous retinal detachment (RRD) or traction retinal detachment (TRD) complicated by serous choroidal detachment (CD). Choroidal detachment is a rare complication of retinal detachment and the current literature cites generally poor visual outcome variables. By investigating a retrospective case series, we hope to elucidate new relationships and embolden existing ones so that future physicians can make more educated decisions regarding the care for these complicated patients. METHODS: A retrospective case series analyzed 18 patient’s medical records (18 eyes) who had been diagnosed and surgically treated for RRD or TRD associated with a CD at the Longwood Medical Eye Center at Beth Israel Deaconess Medical Center. Patients with RDCD who had undergone 23-gauge pars plana vitrectomy with silicone oil tamponade were selected. Exclusionary criteria included ocular complications such as phthisis bulbi and open globe trauma. Patients experienced a variety of surgical procedures including by not limited to relaxing retinotomy (n=12 eyes), choroidal drainage (n=10 eyes), endoscopy-assisted PPV (n=10 eyes), and ERM peeling (n=8 eyes). Primary outcome variables tabulated were primary and final anatomic success, defined as successful reattachment of the retina to the underlying choroid, and final visual acuity. RESULTS: The mean age of the sample group was 69 with 8 patients (44%) diagnosed with preoperative hypotony (IOP <= 6 mmHg). A total of 12 patients were pseudophakic (67%). With a mean follow-up of 21.6 months, patients exhibited expected visual outcomes with 6 patients (33%) improving visual acuity and 7 patients (39%) decreasing visual acuity. Final anatomic success was seen in 17 cases (94%). A significant correlation was found between decreased number of previous surgeries and better visual outcomes (change in BCVA). Another significant relationship correlates choroidal drainage with worse visual outcomes (change in BCVA). Finally, patients who received ERM peeling had better rates of primary anatomic success. CONCLUSION: The advanced age of the sample lends itself to increased risk for cataracts and thus pseudophakia. In addition, high rates of diabetes and macular degeneration follow. The pathophysiology of RDCD in relation to the risk factors of hypotony and macular holes is possibly based on the Starling forces and favorable fluid transudation into the suprachoroidal space. Although the outcomes of this study were similar to previous literature, the visual outcomes are still poor at best. Reducing the number of previous, invasive, ocular surgeries was seen to be correlated with better visual outcomes. In addition, performing ERM peels is seen to be correlated with improved rates of primary anatomic success. More research is required on the etiology of the disease process and a case-controlled longitudinal study may be helpful in determining more relationships with outcome variables.
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