Anatomical and functional outcome of surgery of primary rhegmatogenous retinal detachment in high myopic eyes

Abstract

Purpose To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. Methods We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. Results Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. Conclusions The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives

“…The ages of the subjects should especially be considered. The average age was 33.2–35.9 in the studies among patients with high myopia,51–53 which was younger than 38.9–61.3 in the studies among patients with RRD including non-high myopia and high myopia 8,16,41,55,56. It suggests that SB was performed in younger age in high myopic patients.…”

Results of pars plana vitrectomy for primary rhegmatogenous retinal detachment with PVR grades A and B in high-myopic eyes

“…The final reattachment rate was 97.2% for the SB group and 100% for the PPV group. Cheng et al [9] reported the anatomical success rate in the amount of 86.5% after the primary vitreoretinal surgery and the final anatomical success rate was 100%. Bernheim et al [10] showed in their prospective study the final reattachment rate referring to the high myopia in the amount of 96%.…”

“…Kwok et al [8] reported that 62.5% of the eyes undergoing the primary pars plana vitrectomy reached the visual acuity of 20/60 or better. Cheng et al [9] demonstrated that 26.3% of eyes achieved the postoperative vision 20/50 or better in the pars plana group and 68.5% of the eyes in the scleral buckling group. The obvious difference in functional result between both groups could be explained by the fact that the vitrectomy was used only in more complicated RD cases.…”

“…Bernheim et al [10] showed in their prospective study the final reattachment rate referring to the high myopia in the amount of 96%. The increased use of PPV, already described in association with the other diseases, reduces the operating time, allows better visualization of breaks, increases the single retinal reattachment rate [8,9] and reduces the refractive changes compared to the scleral buckle surgery [11][12][13][14]. Due to the anatomical specifics, the RDD surgery of high-myopic eyes is challenging and the SSSR was reported to be lower than that in nonmyopic eyes [6].…”

Tamponade or Filling Effect: Changes of Forces in Myopic Eyes

“…Because of the very long axial length and the generalized thinning of the sclera, muscle avulsion, vortex vein damage, hemorrhage, retention of subretinal fluid after internal drainage, and risk of globe perforation have been noted during surgery in highly myopic eyes [5, 6]. …”