CLINICAL RISE FACTORS PREDISPOSING FAILUR E IN RHEGMATOGENOUS RETINAL-DETACHMENT SURGERY

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.