A Model for Prediction of Rhegmatogenous Retinal Re-Detachment After Primary Pars Plana Vitrectomy
DOI:
https://doi.org/10.48560/rspo.38166Keywords:
Postoperative Complications, Retinal Detachment, Visual Acuity, VitrectomyAbstract
INTRODUCTION: Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and a frequent cause of vision loss. However, re-detachment is still a significant cause of morbidity. This study aims to identify risk factors and develop a prediction model for RD re-detachment after primary pars plana vitrectomy (PPV).
METHODS: Retrospective analysis of clinical data of RRD undergoing primary 23-gauge (G) PPV between January 2020 and December 2023 at the Surgical Retina Unit of a tertiary hospital. Demographic and surgical data were collected. The main outcome was surgical failure within six months of surgery. Patients submitted to prior retina surgery, other techniques than PPV or incomplete follow-up were excluded.
RESULTS: We identified 1483 vitreoretinal surgeries. Four-hundred and fifty cases were excluded due to diagnostic mislabeling (83), secondary surgery (309), or surgery other than PPV (58). Four-hundred and sixty-two cases were excluded due to insufficient data, follow-up losses or follow-up at different institutions. The final sample rendered 571 surgeries of 552 patients. Mean age was 68.9 ± 14.4 years, and 36.0% (198) of patients were female. The mean time from symptom onset to PPV was 6.22 ± 17.3 days. Regional analysis revealed delayed diagnosis for patients living further away when compared to the referral center district (12.3 ± 23.4 vs 4.8 ± 12.3 days, p=0.023, respectively). A primary anatomical failure occurred in 20.8%. On multivariate analysis, inferior breaks (OR [95%CI]: 2.41 [1.48-4.53], p=0.007), perfluoropropane gas tamponade (OR [95%CI]: 2.09 [1.34-3.27], p=0.001), axial length superior to 26.0 mm (OR [95%CI]: 3.53 [1.41-8.86], p=0.007), choroidal detachment (OR [95%CI]: 4.85 [1.37-17.1], p=0.014), total RD (OR [95%CI]: 2.03 [1.17-3.53], p=0.012) and subretinal fluid drainage through surgically induced retinotomy (OR [95%CI]: 2.37 [1.06-5.32], p=0.036) were associated with increased risk of failure. A prediction model revealed a risk for surgical failure of 16.7% if no risk factors were present (p<0.001) and 66.7% if more than one risk factor was present (p<0.001).
CONCLUSION: Our study provides novel information about the outcomes of RRD after primary 23G PPV. Identification of high-risk features may improve risk stratification and tailored patient counseling and selection.
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