Outcomes After Failed Pneumatic Retinopexy for Retinal Detachment
Anaya, Joseph Anthony
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CitationAnaya, Joseph Anthony. 2017. Outcomes After Failed Pneumatic Retinopexy for Retinal Detachment. Doctoral dissertation, Harvard Medical School.
AbstractObjective: Provide visual and anatomic outcomes for patients with retinal detachment who failed primary pneumatic retinopexy (PR).
Design: Retrospective, single-center, consecutive case series
Subjects: Eyes with retinal detachment (RD) that failed a primary PR.
Methods: Anatomic and functional outcomes were evaluated for patients receiving treatment for failed PR. Three secondary procedures were compared including repeat PR, pars plana vitrectomy (PPV), and combined scleral buckle/pars plana vitrectomy (SB/PPV).
Main outcome measures: Anatomic reattachment and visual acuity at 1 year.
Results: Of a total of 423 primary PR’s performed for RD, this study included 73 cases that failed. The overall single surgery anatomic success rate for the secondary procedure was 75%; the final success rate at one year was 100%. There was no statistically significant difference in success rates between repeat PR (63%), PPV (76%), and SB/PPV (88%). Improvement in visual acuity was similar at one year between all three groups. Visual acuity at one year was similar between eyes undergoing PPV and SB/PPV (LogMAR VA 0.47 [20/59] for PPV and LogMAR VA 0.52 [20/66] for SB/PPV, p = 0.75). Visual acuity at one year was better for those without macular involvement at the time of secondary procedure compared to eyes whose maculae detached (LogMAR VA 0.29 [20/39] vs LogMAR VA 0.73 [20/106], p < 0.005). Fifty percent of PR failures underwent a secondary procedure within 1 week of primary PR; 80% occurred within 1 month.
Conclusions: Anatomic success rates for secondary PR, PPV, and SB/PPV after failed PR were lower than published success rates for their use in primary RD. This suggests that a failed primary PR selects for retinal detachments that are inherently more difficult to reattach. There was a trend suggesting anatomical success rates are greater with SB/PPV than PPV and, in turn, with PPV than repeat PR. However, these differences were not statistically significant and did not translate into better visual acuity gains at one year for either procedure. A randomized controlled trial is necessary to best determine the most effective procedure after a failed pneumatic.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:40621401