Stratifying the risk of re-detachment: variables associated with outcome of vitrectomy for rhegmatogenous retinal detachment in a large UK cohort study

• Published in: Eye (London) Vol. 37; no. 8; pp. 1527 - 1537
• Main Authors: Yorston, David, Donachie, Paul H. J., Laidlaw, D. A., Steel, David H., Aylward, G. W., Williamson, Tom H.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-06-2023; Nature Publishing Group
• Subjects: 692/308/409; 692/499; Accreditation; Article CME; Clinical trials; CME; Cohort analysis; Cohort Studies; Cryotherapy; Education; Educational objectives; Eye; Female; Humans; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Ophthalmology; Patients; Pharmaceutical Sciences/Technology; Retina; Retinal detachment; Retinal Detachment - etiology; Retrospective Studies; Scleral Buckling - adverse effects; Silicone Oils; Silicones; Surgery; Surgical Oncology; Tamponade; Treatment Outcome; United Kingdom - epidemiology; Vitrectomy - adverse effects; United Kingdom; United Kingdom > UK
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-023-02388-0

Learning Objectives
Upon completion of this activity, participants will:
Assess variables associated with primary anatomical outcome (anatomical failure within 6 months of surgery) after vitrectomy and internal tamponade for rhegmatogenous retinal detachment, based on a retrospective analysis of prospectively collected data
Evaluate risk stratification using a multivariate logistic regression model incorporating variables associated with anatomical failure within 6 months of rhegmatogenous retinal detachment surgery, based on a retrospective analysis of prospectively collected data
Determine the clinical implications of variables associated with primary anatomical outcome (anatomical failure within 6 months of surgery) after vitrectomy and internal tamponade for rhegmatogenous retinal detachment, based on a retrospective analysis of prospectively collected data.
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EDITOR
Sobha Sivaprasad, MD, Editor,
Eye
Authors/Editors disclosure information
David Yorston, FRCOphth, Gartnavel Hospital, Glasgow, Scotland. Paul H.J. Donachie, MSc, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom, The Royal College of Ophthalmologists, National Ophthalmology Database Audit, London, United Kingdom. D.A. Laidlaw, MD, FRCOphth, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom. David H. Steel, MD, FRCOphth, Sunderland Eye Infirmary, Sunderland, United Kingdom, Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom. G.W. Aylward, MD, FRCOphth, Moorfields Eye Hospital City Road, London, United Kingdom. Tom H. Williamson, MD, FRCOphth, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
Journal CME author disclosure information
Laurie Barclay has disclosed the following relevant financial relationships: formerly owned stocks in AbbVie Inc.
Introduction
To identify variables associated with primary anatomical outcome following vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD).
Methods
A retrospective analysis of prospectively collected data, using a database of RD treated with vitrectomy and internal tamponade. Collected data complied with the RCOphth Retinal Detachment Dataset. The main outcome measure was anatomical failure within six months of surgery.
Results
There were 6377 vitrectomies. 869 eyes were excluded, either because no outcome was recorded, or inadequate follow up, leaving 5508 operations for analysis. 63.9% of patients were male, and the median age was 62. Primary anatomical failure occurred in 13.9%. On multivariate analysis, the following were associated with increased risk of failure: age <45, or >79, inferior retinal breaks, total detachment, one quadrant or greater inferior detachment, low density silicone oil, and presence of proliferative vitreoretinopathy. C
2
F
6
tamponade, cryotherapy, and 25 G vitrectomy, were associated with reduced risk of failure. The area under the receiver operator curve was 71.7%. According to this model, 54.3% of RD are at low risk (<10%), 35.6% are at moderate risk (10–25%), and 10.1% are at high risk (>25%) of failure.
Conclusions
Previous attempts to identify high risk RD have been limited by small numbers, the inclusion of both scleral buckling and vitrectomy, or by excluding some types of RD. This study examined outcomes in unselected RD, treated by vitrectomy. Identification of the variables associated with anatomical outcome after RD surgery enables accurate risk stratification, which is valuable for patient counselling and selection, and for future clinical trials.