Retinal detachment surgery

Databases highlight risk factors for failure in detachment surgery

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Information mined from the EURETINA and the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) retinal detachment (RD) databases is enabling vitreoretinal surgeons to identify and quantify with much greater precision the potential risk factors for failure in RD surgery, according to David Yorston MBChB. “So far, we have over 6,000 retinal detachments in the database, of which the great majority have been entered by surgeons from the UK. It costs virtually nothing to accumulate a large amount of data, and we have shown the proof of principle that online data collection in a collaborative way is feasible and relatively simple,” Dr Yorston told delegates attending the 8th EURETINA Winter Meeting in Budapest. Dr Yorston, Consultant Ophthalmologist at Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, UK, presented data based on 4,400 RDs entered before 1 February 2017 by BEAVRS members. The data showed that the peak incidence of RD is in the seventh decade, with right eyes affected more than left. A majority, 63%, were males. Some 80% of the RDs were due to a horseshoe tear followed by round holes and retinal dialyses. The great majority of detachments were treated with 23-gauge vitrectomy, and just 10% with scleral buckle, said Dr Yorston. To focus on the adjusted failure rates, scleral buckle surgeries were excluded and only patients who were treated with a primary vitrectomy were included. This left slightly less than 4,000 eyes, with a failure rate of just over 13% and a follow-up of 91%. Risk factors for failure included inferior breaks, grade-B or -C proliferative vitreoretinopathy, total detachments and schisis RD. “We all know that the greater the extent of the RD, the more likely the chance of experiencing a primary anatomical failure. But perhaps what we did not realise was the extent to which the risk increases going from 11 o’clock hours to 12 o’clock hours. The risk doubles, so something more is happening with total retinal detachments,” said Dr Yorston. While inferior breaks were also shown to be a risk factor for failure, the progression was not linear. “There was no increase in risk between breaks at 12 o’clock to 3 o’clock, it increased slightly at 4 o’clock and then doubles from 5 to 6 o’clock,” he said. Summing up, Dr Yorston said that the greater the extent of the detachment, the greater the risk of failure, and that the risk increases dramatically with a total detachment. Patients with inferior breaks have a worse prognosis and the risk increases significantly with a break near 6 o’clock. “I believe that this is also the first study to report that endolaser may be associated with a greater risk of failure than cryotherapy, and because this takes account of case complexity it is not just because these are the more complex detachments,” he concluded.
Tags: BEAVRS, retinal detachment