Visual acuity (best with correction or pinhole) was converted from Snellen acuity to logMAR to allow statistical analysis. Patients whose operations involved the use of silicone oil were not considered to be primary or ultimate successes unless oil was subsequently removed without redetachment. Ultimate anatomical success included primary anatomical success as well as those patients for whom a reattached retina was achieved with subsequent surgery. Primary anatomical success was defined as a reattached retina after one procedure and remaining attached to final follow-up. The operations were carried out between 13/11/98 and 10/2/01 and follow-up was 4 months to 2.5 years. Trainees performed 93 of the 185 operations. The series was an unbiased selection of cases under the care of two consultants (THW: n=110 and DAHL: n=75) in a vitreoretinal unit of a teaching hospital. Macular detachment was defined as detachment involving the fovea with any resulting loss of central Snellen visual acuity. 4 This study of the surgical management of macula-off retinal detachments determines anatomical and visual outcomes and attempts to determine which preoperative factors influenced these outcomes in the setting of a modern vitreoretinal unit.Ī retrospective casenote review was carried out of 185 patients presenting with primary macula-off retinal detachment. In recent years, a shift towards the increasing use of primary internal pars plana vitrectomy away from these conventional buckling techniques has been seen. The reasons for poor visual acuity cannot always be determined and previous studies relate mainly to the outcomes for patients who have undergone ‘conventional’ external scleral buckling surgery with or without external drainage. 3 However, for retinal detachments with macular detachment primary anatomical success does not necessarily achieve a good visual outcome and the functional results vary greatly. 1, 2 Failure to achieve a primary anatomical success (retinal reattachment with one operation) reduces the chance of a good visual outcome. The primary anatomical success rate of surgery for retinal detachment can be high and should be in the range of 80–90%. Preoperative PVR, number of breaks and duration of detachment also affect outcomes. Preoperative visual acuity is the most important factor predicting primary and final anatomical success as well as visual outcome. The median logMAR acuity increment of 0.78 far exceeds that seen in cataract surgery. In all, 76% of macula-off detachments may be repaired with one operation and 44% of patients regain at least 6/12 Snellen. For prediction of visual outcome (in patients with no ocular comorbidity) only preoperative logMAR visual acuity achieved statistical significance ( P=0.001) at the P=0.05 level. In all, 44% of patients regained 6/12 Snellen or better with a median improvement of 0.78 logMAR. Preop logMAR visual acuity and duration of macular detachment were the statistically significant factors predicting ultimate success. Statistically significant factors predicting primary anatomical success using a multiple variable model were preoperative logMAR visual acuity, preoperative PVR and number of breaks. Patients with oil in at final follow-up were considered to be anatomical failures. Primary and ultimate anatomical success were achieved in 76 and 84% of cases. Logistic regression analysis was used to determine (1) the effect of these factors on visual outcome and (2) their effect on primary and final anatomical success. Demographic and ocular characteristics were determined. MethodsĪ retrospective casenote review of 185 patients presenting with macula-off retinal detachment was performed. To determine factors associated with anatomical and functional outcomes of macula-off retinal detachment surgery in a modern vitreoretinal unit.
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