OBJECTIVE: To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). DESIGN: Nonrandomized, multicenter, retrospective study. PARTICIPANTS: One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. METHODS: Reported data included clinical manifestations, the method of repair, and the outcome. MAIN OUTCOME MEASURES: 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). RESULTS: 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)). CONCLUSIONS: 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. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2 / Benmerzouga, N; Metti, F; Razzari, A; Miesbauer, P; Schönherr, U; Zeynalova, Z; Bashir, Sj; Jacob, J; Koch, P; Ladha, R; Smets, E; Stalmans, P; Dare, A; Devenyi, R; Lam, Wc; Shaheeda, M; Potamitis, T; Christensen, Sr; Rayes, E; Mortada, H; Shouman, A; Holm, M; Albinet, P; Amar, Jp; Becquet, F; Berrod, Jp; Boulze, M; Boscher, C; Courjaret, Jc; Denion, E; Fourmaux, E; Guigou, S; Hamon, F; Lafontaine, Po; LE ROUIC, Jf; Leynaud, Jl; Nochez, Y; Perone, Jm; Rysanek, B; Soyeur, R; Bopp, S; Brix, A; Höhn, F; Kusserow, C; Lucke, K; Mohr, A; Schüler, A; Weinberger, A; Gotzaridis, S; Karatzenis, D; Stefaniotou, M; K., TSILIMBARIS MK; Tsouris, D; Tsang, Cw; Gabor, R; Szijarto, Z; Babu, N; Banker, As; Bapaye, M; Kelkar, A; Entezari, M; FATEH MOGHADAM, Hf; Ramezani, A; SAFARPOUR LIMA, B; Omer, K; Boscia, F; CHIARA FRENO, M; Cian, R; Donvito, G; Facino, M; Lesnoni, G; Liuzzi, F; Mete, M; Mininni, F; Mochi, B; Primavera, V; Romano, Mario; Pertile, G; Turco, I; Vastarella, P; Fong, K; Lee, M; VP LOO, A; ARAGON HARRISON, O; FLORES AGUILAR, M; LOPEZ MONTERO, Lm; LOPEZCARASA HERNANDEZ, G; Velasco, I; Boeyden, V; Bosscha, M; DE VRIES KNOPPERT, W; Lindstedt, ; E., RENARDEL DE LAVALETTE VW; VAN DEN BIESEN, Pr; Alhassan, M; Baerland, Tp; Bober, Am; Forsaa, V; Fossen, K; Varhaug, P; ATIENZA J. r., Nf; Cisiecki, S; Fryczkowski, P; KOWAL LANGE, A; Michalewska, Z; Michalewski, J; Nawrocki, J; Nowosielska, A; Odrobina, D; PIETRAS TRZPIEL, M; Zakrzewska, A; Meireles, A; Teixeira, S; Elshafei, M; Danielescu, C; Talu, S; Altynbaev, U; Gorin, A; Serejine, I; EL DEEB, M; Davidovic, S; Ignjatovic, Z; Stefanickova, J; Venter, L; Chang, W; Jo, Yl; Kim, Jy; Lee, J; Lim, St; Sagong, M; Ascaso, Fj; Castro, J; CORDOVES L., DESCO ESTEBAN C; MORENO MANRESA, J; Vilaplana, D; Janiec, S; Tomic, Z; BEN YAHIA, S; Acar, N; Güngel, H; Kapran, Z; Osmanbasoglu, O; Ozdek, S; Topbas, S; Totan, Y; Ünver, Yb; Chichur, D; Dobrovolskey, O; Kozlovska, I; Lytvynchuk, L; Phylypchuk, O; Postolovska, A; Sergiienko, A; Shevchyk, V; Winder, S; Culotta, J; Kim, S; King, J; Kurup, Sk; Lin, Sj; Pacurariu, R; Roth, D; Sinclair, S; Weber, P; Doan, H; Tung, T.. - In: OPHTHALMOLOGY. - ISSN 0161-6420. - 120:9(2013), pp. 1809-1813. [10.1016/j.ophtha.2013.01.056]
Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2
ROMANO, MARIO;
2013
Abstract
OBJECTIVE: To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). DESIGN: Nonrandomized, multicenter, retrospective study. PARTICIPANTS: One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. METHODS: Reported data included clinical manifestations, the method of repair, and the outcome. MAIN OUTCOME MEASURES: 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). RESULTS: 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)). CONCLUSIONS: 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. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
