Clinical variables associated with failure of retinal detachment repair: the European vitreo-retinal society retinal detachment study report number 4
Abstract
OBJECTIVE: To identify risk factors associated with failure of anatomic reattachment in primary rhegmatogenous retinal detachment repair. DESIGN:Nonrandomized, multicenter, collaborative study.
PARTICIPANTS: Primary procedures for 7678 rhegmatogenous retinal detachments reported by 176 surgeons from 48 countries. METHODS: We recorded specific preoperative clinical findings, repair method, and outcome after intervention.
We performed univariate, bivariate, and multivariate analyses to identify variables associated with surgical failure. MAIN OUTCOME MEASURES: Final failure of retinal detachment repair (level 1), remaining silicone oil at study conclusion (level 2), and need for additional procedures to repair the detachment (level 3).
RESULTS: We analyzed 7678 cases of rhegmatogenous retinal detachment repair. Presence of choroidal detachment or significant hypotony was associated with significantly higher level 1 failure rates when grade 0 or B proliferative vitreoretinopathy (PVR) was present and higher level 2 failure rates, regardless of PVR status (P<0.05).
Excluding cases with choroidal detachment or hypotony, increasing PVR was associated with increasing level 1 failure rates. The difference between grade B and C-1 PVR was significant (P = 2 x 10(-6)).
No difference was observed in level 1 failure rates when operated eyes were phakic versus pseudophakic. Level 1 failure was significantly higher when all 4 quadrants of retina (4.4%) were detached than when only 1 quadrant (0.8%) had subretinal fluid.
With grade B or C-1 PVR, cases with large or giant tears had significantly higher level 1 failure rates. No association was observed between number of retinal breaks and failure rates.
Multivariate analysis showed grade C-1 PVR, 4 detached quadrants, and presence of choroidal detachment or significant hypotony were independently linked with a greater level 1 failure rate; the presence of a smaller retinal break was associated with a lesser level 1 failure rate.