The cause of redetachment after vitrectomy with air tamponade for a cohort of 1715 patients with retinal detachment: an analysis of retinal breaks reopening

Abstract

Background To investigate the prevalence and predictors of retinal breaks reopening after vitrectomy with air tamponade in rhegmatogenous retinal detachment (RRD). Methods A retrospective cohort study was conducted in Shanghai General Hospital. Chart review was performed among 1715 patients with primary RRD who received pars plana vitrectomy (PPV) with air tamponade as initial management. Patients were followed up for recurrence. The clinical features of the eyes with retinal breaks reopening were recorded. Logistic regression was constructed to investigate the predictors for breaks reopening. Results A total of 137 (7.99%) patients had recurrent retinal detachment after PPV with air tamponade. The causes of surgery failure included new or missed retinal breaks (48.9%), reopening of original tears (43.8%) and proliferative vitreoretinopathy (7.3%). The median time to recurrence for the patients with breaks reopening was 18.0 days. Multivariate logistic regression indicated that the presence of retinal break(s) ≥ 1.5 disc diameters (DD) (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 11.04–6.92, P = 0.041), and shorter period for restricted activities (OR: 0.94, 95% CI: 0.89–0.99, P = 0.020) were the independent predictors for breaks reopening. Conclusions Breaks reopening is an important cause for retinal redetachment after PPV with air tamponade in primary RRD. The first 2–4 weeks after surgery is the “risk period” for breaks reopening. Special attention should be paid for patients with retinal break(s) ≥ 1.5 DD. A prolonged period for restricted activities is recommended.

Late Recurrence of Retinal Detachment: Incidence, Clinical Features and Surgical Outcomes

“…Retinal detachment can recur secondary to undetected or new retinal breaks, inadequate or excessive retinopexy (causing necrosis), and PVR. 7 Often redetachment occurs between the second and eighth weeks; 8,9 however, the incidence, clinical features, and prognosis of patients who developed a late recurrence of retinal detachment after vitrectomy-repaired RRD have not being well described. Girard et al 10 analyzed 1,136 eyes, finding 51 cases of late recurrence of RRD, with a success rate of reattachment of 85.7%; however, in this series, there was a variety of operative techniques and diagnoses, including three macular hole–associated RRDs.…”