Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2

• Published in: Ophthalmology (Rochester, Minn.) Vol. 120; no. 9; pp. 1809 - 1813
• Main Authors: Adelman, Ron A, Parnes, Aaron J, Sipperley, Jack O, Ducournau, Didier
• Format: Journal Article
• Language: English
• Published: United States 01.09.2013
• Subjects: Choroid Diseases - complications; Choroid Diseases - surgery; Endotamponade - methods; Europe; Fluorocarbons - administration & dosage; Health Care Surveys; Humans; Ophthalmology; Retinal Detachment - etiology; Retinal Detachment - surgery; Retinal Perforations - complications; Retinal Perforations - surgery; Retrospective Studies; Scleral Buckling - methods; Silicone Oils - administration & dosage; Societies, Medical; Treatment Outcome; Vitrectomy - methods; Vitreoretinopathy, Proliferative - complications; Vitreoretinopathy, Proliferative - surgery; Europe
• ISSN: 1549-4713
• DOI: 10.1016/j.ophtha.2013.01.056

To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter, retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. Reported data included clinical manifestations, the method of repair, and the outcome. Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)). In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful. The author(s) have no proprietary or commercial interest in any materials discussed in this article.