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Klin Monbl Augenheilkd 2003; 220(3): 116-121
DOI: 10.1055/s-2003-38189
Klinische Studie
© Georg Thieme Verlag Stuttgart · New York

Analysis of Risk Factors for the Outcome of Primary Retinal Reattachment Surgery in Phakic and Pseudophakic Eyes

Risikofaktoren für den Erfolg der primären Amotiochirurgie an phaken und pseudophaken AugenMarkus  Halberstadt1 , Lucia  Brandenburg1 , Nathalie  Sans1 , Ursula  Koerner-Stiefbold1 , Fritz  Koerner1 , Justus  G.  Garweg1
  • 1Department of Ophthalmology, University of Bern, Inselspital, Bern, Switzerland (Director: Prof. Dr. med. F. Körner)
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Publication History

Eingegangen: 1. Oktober 2002

Angenommen: 5. November 2002

Publication Date:
28 March 2003 (online)

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Zusammenfassung

Hintergrund: Ziel der vorliegenden Studie war der Vergleich der prä-, intra- und postoperativen Situation in phaken und pseudophaken Augen mit frischer Amotio retinae, um ein Risikoprofil für den Operationserfolg nach primärer Amotiochirurgie zu erstellen. Patienten und Methoden: 220 konsekutive Patienten mit primärer Amotio retinae, 165 phake und 55 pseudophake Augen wurden einer Buckelchirurgie (Plombe/Cerklage) allein oder in Kombination mit einer Vitrektomie unterzogen. Prä-, intra- und postoperative Risikofaktoren wurden erfasst und deren Einfluss auf das anatomische und funktionelle Resultat mittels einer multivariaten Regressionsanalyse verglichen. Ergebnisse: Die kumulativen anatomischen Erfolgsraten nach 6 Monaten waren in phaken (88,5 %) und pseudophaken (86,3 %) Augen gleich (log rank = 0,340). Die Amotioausdehnung erwies sich in pseudophaken Augen als ein stärkerer Risikofaktor für die Beeinträchtigung des operativen Erfolges als in phaken Augen (p = 0,035). Bei phaken Augen zeigte sich kein Einfluss der Amotioausdehnung auf das chirurgische Resultat (1 Quadrant vs. 4 Quadranten; log rank = 0,135); während bei Pseudophakie eine Beeinträchtigung der Amotioausdehnung auf das chirurgische Resultat nachweisbar war (1 Quadrant vs. > 4 Quadranten; log rank < 0,001). Das relative Risiko einer Reamotio nach operativer Versorgung einer Amotio retinae ab 3 Quadranten betrug bei Normophakie 1,22 (CI: 0,71 - 1,70) und bei Pseudophakie 1,81 (CI: 0.88 - 2,59). Schlussfolgerungen: Bis zu einer Amotioausdehnung von 3 Quadranten weisen phake und pseudophake Augen ähnliche chirurgische Erfolgsraten auf. Ab einer Ausdehnung der Amotio retinae größer als neun Stunden findet sich im pseudophaken Auge, im Gegensatz zum phaken Auge, bei alleiniger eindellender Operation ein negativer Einfluss der Amotioausdehnung auf den Operationserfolg. Dieser kann durch ein kombiniertes extra- und intraokulares Vorgehen mit Vitrektomie reduziert werden.

Abstract

Background: To compare the preoperative risk profiles of phakic and pseudophakic eyes with primary retinal detachment and to assess their impact on the outcome of primary reattachment surgery. Patients and methods: 220 consecutive patients with primary retinal detachment, 165 phakic and 55 pseudophakic eyes were operated with scleral buckling alone or additional vitrectomy and followed up for 6 months. Pre-, intra- and postoperative risk factors were recorded and their impact on anatomical outcome after primary surgery in phakic and pseudophakic eyes was then compared in a multivariate regression analysis. Results: The cumulative probability of anatomical success 6 months after surgery was similar in phakic (88.5 %) and pseudophakic eyes (86.3 %; log rank = 0.340). The most important risk factor for a different surgical outcome between phakic and pseudophakic eyes was the size of retinal detachment (p = 0.035). In phakic eyes the size of retinal detachment had no significant impact on surgical outcome (1 vs. 4 quadrants; log rank = 0.135); whereas in pseudophakic eyes a significant impairment on surgical outcome was found (1 vs. 4 quadrants; log rank < 0.001). The relative risk for failure of primary surgery due to retinal detachment of at least 3 quadrants was in phakic eyes 1.22 (CI: 0.71 - 1.70), in pseudophakic ones 1.81 (CI: 0.88 - 2.59). Conclusions: The outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes is similar for retinal detachments up to 3 quadrants. In retinal detachments of more than 9 clock times, the size of retinal detachment impairs the surgical outcome in pseudophakic eyes more than in phakic ones. The combination of extraocular surgery with vitrectomy in pseudophakic eyes with retinal detachment of more than 9 clock times contributes to a better outcome.

Schlüsselwörter

Netzhautablösung - Normophakie - Pseudophakie - Risikofaktoren

Key words

Retinal detachment - surgical procedures - phakia, pseudophakia - risk factor, outcome assessment

References

  • 1 Haimann M H, Burton T C, Brown C K. Epidemiology of retinal breaks.  Arch Ophthalmol. 1982;  100 289-292
    CrossrefPubMedGoogle Scholar
  • 2 Minihan M, Tanner V, Williamson T H. Primary rhegmatogenous retinal detachment.  Br J Ophthalmol. 2001;  85 546-548
    CrossrefPubMedGoogle Scholar
  • 3 Ah-Fat F G, Sharma M, Majid M A, McGalliard J N, Wong D. Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996.  Br J Ophthalmol. 1999;  83 396-398
    PubMedGoogle Scholar
  • 4 Gray R H, Evans A R, Constable I J, McAllister I L. Retinal detachment and its relation to cataract surgery.  Br J Ophthalmol. 1989;  73 775-780
    PubMedGoogle Scholar
  • 5 Pervical S P, Anand V, Das S K. Prevalence of aphakic retinal detachment.  Br J Ophthalmol. 1983;  7 43-45
    PubMedGoogle Scholar
  • 6 Claymann H M, Jaffe N S, Light D S, Jaffe M S, Cassady J C. Intraocular lenses, axial length, and retinal detachment.  Am J Ophthalmol. 1981;  92 778-780
    PubMedGoogle Scholar
  • 7 Stark W J, Maumenee A E, Fagadau W R, Hirst L H, Datiles M B. Intraocular lenses: experience at the Wilmer Institute.  Austr J Ophthalmol. 1983;  11 95-102
    PubMedGoogle Scholar
  • 8 Kratz R P, Mazzocco T R, Davidson B D. A comparative analysis of anterior chamber, iris supported, capsule-fixated, and posterior chamber intraocular lenses following cataract extraction by phacoemulsification.  Ophthalmology. 1981;  88 56-58
    PubMedGoogle Scholar
  • 9 Javitt J C, Vitale S, Canner J K, Krakauer H, McBean A M, Sommer A. National outcomes of cataract extraction I. Retinal detachment after inpatient surgery.  Ophthalmology. 1991;  98 895-902
    PubMedGoogle Scholar
  • 10 Leff S R, Welch C J, Tasman W. Rhegmatogenous retinal detachment after YAG laser capsulotomy.  Ophthalmology. 1987;  94 1222-1225
    PubMedGoogle Scholar
  • 11 Yoshida A, Ogasawara H, Jalkh A E, Sanders R J, McMeel J W, Schepens C L. Retinal detachment after cataract surgery. Predisposing factors.  Ophthalmology. 1992;  99 453-459
    PubMedGoogle Scholar
  • 12 Yoshida A, Ogasawara H, Jalkh A E, Sanders R J, McMeel J W, Schepens C L. Retinal detachment after cataract surgery. Surgical results.  Ophthalmology. 1992;  99 460-465
    PubMedGoogle Scholar
  • 13 Bovey E H, Gonvers M, Sahli O. Traitement chirurgical du décollement de rétine chez le pseudophaque: comparison entre la vitrectomie et la compression épisclérale.  Klin Monatsbl Augenheilkd. 1998;  212 314-317
    PubMedGoogle Scholar
  • 14 Bradford J D, Wilkinson C P, Fransen S P. Pseudophakic retinal detachments.  Retina. 1989;  3 181-186
    PubMedGoogle Scholar
  • 15 Wilkinson C P. Retinal detachments following intraocular lens implantation.  Ophthalmology. 1981;  88 410-413
    PubMedGoogle Scholar
  • 16 Wilkinson C P. Pseudophakic retinal detachments.  Retina. 1985;  5 1-4
    PubMedGoogle Scholar
  • 17 Törnquist R, Bodin L, Törnquist P. Retinal detachment: a study of a population-based patient material in Sweden 1971 - 1981. IV. Prediction of surgical outcome.  Acta Ophthalmol. 1988;  66 637-642
    PubMedGoogle Scholar
  • 18 Törnquist R, Törnquist P. Retinal detachment: a study of a population-based patient material in Sweden 1971 - 1981. III. Surgical results.  Acta Ophthalmol. 1988;  66 630-636
    PubMedGoogle Scholar
  • 19 American Academy of Ophthalmology . The repair of rhegmatogenous retinal detachments.  Ophthalmology. 1990;  97 1562-1572
    PubMedGoogle Scholar
  • 20 Heimann H, Hellmich M, Bornfeld N, Bartz-Schmidt K U, Hilgers R D, Foerster M H. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study): Design issues and implications. SPR Study Report No. 1.  Graefe's Arch Clin Exp Ophthalmol. 2001;  239 567-574
    CrossrefPubMedGoogle Scholar
  • 21 Newmann D R, Burton R L. Primary vitrectomy for pseudophakic and aphakic retinal detachments.  Eye. 1999;  13 635-639
    PubMedGoogle Scholar
  • 22 The Retina Society Terminology Committee . The classification of retinal detachment with proliferative vitreoretinopathy.  Ophthalmology. 1983;  90 121-125
    PubMedGoogle Scholar
  • 23 Törnquist R, Stenkula S, Törnquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971 - 1981. I. Epidemiology.  Acta Ophthalmol. 1987;  65 223-230
    PubMedGoogle Scholar
  • 24 Heimann H, Bornfeld N, Friedrichs W, Helbig H, Kellner U, Korra A, Foerster M H. Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment.  Graefe's Arch Clin Exp Ophthalmol. 1996;  234 561-568
    PubMedGoogle Scholar
  • 25 Binkhorst C D. Corneal and retinal complications after cataract extraction.  Ophthalmology. 1980;  87 609-617
    PubMedGoogle Scholar
  • 26 Rachal W F, Burton T C. Changing concepts of failures after retinal detachment surgery.  Arch Ophthalmol. 1979;  97 480-483
    PubMedGoogle Scholar
  • 27 Yusuke O, Kazuyuki E, Masanobo M, Yamanishi S. Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachment.  Jpn J Ophthalmol. 1999;  43 120-126
    CrossrefPubMedGoogle Scholar
  • 28 Cowley M, Conway B P, Camochiaro P A, Kaiser D, Gaskin H. Clinical risk factors for proliferative vitreoretinopathy.  Arch Ophthalmol. 1989;  107 1147-1151
    PubMedGoogle Scholar
  • 29 Girard P, Mimoun G, Karpouzas I, Montefiore G. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery.  Retina. 1994;  14 417-424
    PubMedGoogle Scholar
  • 30 Devenyi R G, de Carvalho Nakamura H. Combined scleral buckle and pars plana vitrectomy as primary procedure for pseudophakic retinal detachments.  Ophthalmic Surg Lasers. 1999;  30 615-618
    PubMedGoogle Scholar
  • 31 Oshima Y, Emi K, Motokura M, Yamanishi S. Survey of surgical indications and results of primary pars plana vitrectomy for rheghmatogenous retinal detachments.  Jpn J Ophthalmol. 1999;  43 120-126
    CrossrefPubMedGoogle Scholar
  • 32 Bartz-Schmidt K U, Kirchhof B, Heimann K. Primary vitrectomy for pseudophakic retinal detachment.  Br J Ophthalmol. 1996;  80 346-349
    CrossrefPubMedGoogle Scholar
  • 33 Ho P C, Tolentino F I. Pseudophakic retinal detachment. Surgical success rate with various types of IOLs.  Ophthalmology. 1984;  91 847-852
    PubMedGoogle Scholar
  • 34 Vatane H O, Syrdalen P. Retinal detachment after intraocular lens implantation.  Acta Ophthalmol. 1986;  64 544-546
    PubMedGoogle Scholar
  • 35 Schwartz S G, Kuhl D P, McPherson A R, Holz E R, Mieler W F. Twenty-year follow-up for scleral buckling.  Arch Ophthalmol. 2002;  120 325-329
    CrossrefPubMedGoogle Scholar
  • 36 Chignell A H, Fison L G, Davies E W, Hartley R E, Gundry M F. Failure in retinal detachment surgery.  Mod Probl Ophthalmol. 1974;  12 20-28
    PubMedGoogle Scholar
  • 37 Wong D, Billington B M, Chignell A H. Pars plana vitrectomy for retinal detachment with unseen retinal holes.  Graefe's Arch Clin Exp Ophthalmol. 1987;  225 269-271
    PubMedGoogle Scholar
  • 38 Sullivan P M, Luff A J, Aylward G W. Results of primary retinal reattachment surgery: a prospective audit.  Eye. 1997;  11 869-871
    PubMedGoogle Scholar
  • 39 Hakin K N, Lavin M J, Leaver P K. Primary vitrectomy for rhegmatogenous retinal detachment.  Graefe's Arch Clin Exp Ophthalmol. 1993;  231 344-346
    PubMedGoogle Scholar
  • 40 Cousins S, Boniuk I, Okun E, Johnston G P, Arribas N P, Escoffery R F, Burgess D B, Grand M G, Olk R J, Schoch L H. Pseudophakic retinal detachments in the presence of various IOL types.  Ophthalmology. 1986;  93 1198-1208
    PubMedGoogle Scholar
  • 41 Hagler W S. Pseudophakic retinal detachment.  Trans Am Ophthalmol Soc. 1982;  80 45-63
    PubMedGoogle Scholar

Markus Halberstadt,MD 

Dept. of Ophthalmology · Inselspital

3010 Bern · Switzerland

Email: markus.halberstadt@insel.ch

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