G. Mangouritsas et al., CLINICAL RISE FACTORS PREDISPOSING FAILUR E IN RHEGMATOGENOUS RETINAL-DETACHMENT SURGERY, Klinische Monatsblatter fur Augenheilkunde, 206(1), 1995, pp. 20-28
Background The evaluation of further rise factors predesposing failure
in retinal detachment surgery than those already known to be associat
ed with PVR was the goal of this retrospective study. Patients and met
hods The data from 130 cases with unilateral rhegmatogenous retinal de
tachment treated initially with buckling procedures, were retrospectiv
ely reviewed to investigate pre-, intra- and postoperative factors whi
ch may predispose anatomical failure in retinal detachment surgery. No
ne of the selected consecutively operated eyes had rise factors, which
have already been associated with an unfavourable outcome, such as th
e presence of preoperative macular holes, PVR or assumed PVR-inducing
factors, such as ocular trauma, giant retinal tears, vitreous hemorrha
ge, previous vitrectomy, cryopexy and laser photocoagulation. Results
The anatomic success rate after scleral buckling procedures was 78.5%
and the overall success rate after multiple surgery including vitrecto
my increased to 94.6%. 102 (78.5%) cases, treated with a maximum of tw
o scleral buckling operations were statistically compared to the 28 ca
ses which needed further vitreoretinal surgery. The statistical analys
is revealed as preoperative rise factors for failure in rhegmatogenous
retinal detachment surgery 1) retinal detachment exceeding two retina
l quadrants (p < 0.05) and 2) size of the retinal tear larger than 60
degrees (p < 0.05), whereas postoperative rise factors were 1) presenc
e of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal flu
id at least two days after surgery (p<0.01). Eyes with preoperative vi
sual acuity less than 0.1, pseudophacic eyes with posterior chamber in
traocular lenses and eyes with severe intraoperative hypotony also sho
wed a tendency to unfavourable outcome, but without a statistically si
gnificant level. Conclusions Possible ways of interfering in the retin
al reattachment process and the clinical importance of these evaluated
factors are discussed. They should be taken in consideration for the
prognosis of the postoperative anatomical result and treatment modalit
ies if further surgery is required.