Clinical characteristics and prognosis of Total Rhegmatogenous retinal detachment: a matched case-control study

Abstract

Background: Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this study, we investigate the clinical characteristics, risk factors, and prognosis of total RRD. Methods: A retrospective chart review was performed on cases of 44 total RRD and an age-and sex-matched 88 partial RRD. Two groups were compared for clinical characteristics, risk factors, and prognosis. Results: The prevalence of total RRD in all cases of retinal detachment was 4.4%. Pseudophakic eye, ocular trauma, and proliferative vitreoretinopathy (PVR) were significantly associated with a risk of total RRD (P = .002, P = .003, and P < .001, respectively). In the total RRD group, retinal breaks were located in both superior and inferior parts of the retina, and macular holes and giant retinal tears were frequently found. The best-corrected visual acuity (log MAR) before surgery and final best-corrected visual acuity after surgery were 2.23 ± 0.45 and 1.88 ± 0.96, which was significantly poorer than in the partial RRD group (P < .001). The success rate after primary surgery was 75.0% in the total RRD group, which was significantly lower than partial RRD group (P < .001). Old age, pseudophakic eye, and macular hole as the type of retinal break were highly associated with low success rate. (P = .010, P = .0500, and P = .002). Conclusions: Patients with total RRD had higher recurrence rate and poorer visual outcome after surgery than patients with focal RRD. Old age, pseudophakic eye, and presence of macular hole were important risk factors for recurrence after total RRD repair. Additional surgical procedures should be considered to combine with vitrectomy to achieve better surgical outcomes in these patients.

Shorter Axial Length Is a Risk Factor for Proliferative Vitreoretinopathy Grade C in Eyes Unmodified by Surgical Invasion

“…Retinal detachment caused by dialysis and an inferior retinal break may progress slowly, and patients may not become aware of the symptoms at an early stage, which could be associated with the gradual progression of proliferation. A macular hole is reportedly observed frequently in total retinal detachment related to PVR [17]. Previous studies have shown that the baseline presence of PVR-C was related to ocular trauma [6,19] and a past history of uveitis [3,6,19] and inflammation is one of the major components of PVR formation [6,20].…”

“…Primary analysis using the entire cohort revealed that the characteristics of retinal detachment were risk factors for the development of PVR-C: the area of retinal detachment was a risk factor for preoperative PVR-C with an OR of 5.42. In fact, it was reported that a wide area of retinal detachment was associated with PVR-C [17]. However, it is challenging to discern whether the wide area of retinal detachment was the cause or the result of PVR formation, because PVR formation can expand the detachment.…”

“…A shorter AL is also related to a high prevalence of diabetic retinopathy among patients with diabetes [16]. While retinal detachment is often found in eyes with myopia or a long AL [10,17], we hypothesized that retinal detachment in eyes with a shorter AL would frequently have a severe manifestation, i.e., PVR. Since the pathogenesis of PVR involves chronic inflammation, eyes exhibiting preoperative PVR may have had a relatively long history of retinal breaks and/or detachment, irrespective of the identification of the symptoms.…”

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

“…In our study, a considerable number of patients were classified as having complex RD, including those with macular hole (n = 18), complex cataract (n = 26), previous filtering glaucoma surgery (n = 13), chronic RD (n = 9), traumatic RD (n = 43), giant retinal tear (n = 21), total RD (n = 42) and vitreous haemorrhage (n = 82). Some of these factors have been shown to increase the risk of surgical failure, and this may explain our higher recurrence rates [ 18 , 19 , 20 , 21 , 22 , 23 ].…”

The Characteristics of Pseudophakic Retinal Detachment and Risk Factors of Recurrence in the North of Spain

“…Given that cataract surgery is currently the most common ophthalmic surgical procedure performed in our clinical setting [12], and that there is a boom of clear lens extraction in refractive surgery at younger ages, the incidence of PRD is expected to increase in the coming years. It should be noted that pseudophakic patients with RD achieve worse nal visual outcomes and that they experience a higher recurrence rate than phakic patients [13].…”