Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management

Rhegmatogenous retinal detachment (RRD) is a common condition with an increasing incidence, related to the ageing demographics of many populations and the rising global prevalence of myopia, both well known risk factors. Previously untreatable, RRD now achieves primary surgical success rates of over 80%–90% with complex cases also amenable to treatment. The optimal management for RRD attracts much debate with the main options of pneumatic retinopexy, scleral buckling and vitrectomy all having their proponents based on surgeon experience and preference, case mix and equipment availability. The aim of this review is to provide an overview for the non-retina specialist that will aid and inform their understanding and discussions with patients. We review the incidence and pathogenesis of RRD, present a systematic approach to diagnosis and treatment with special consideration to managing the fellow eye and summarise surgical success and visual recovery following different surgical options.

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Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis

Journal of Ophthalmology ◽

10.1155/2016/4538193 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Yong-Kyu Kim ◽

Wontae Yoon ◽

Jae Kyoun Ahn ◽

Sung Pyo Park

Keyword(s):

Retinal Detachment ◽

High Myopia ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Surgical Approaches ◽

Success Rates ◽

Visual Outcomes ◽

Pars Planitis ◽

Preoperative Risk Factors ◽

Anatomical Success

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis.Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups.Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p<0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%,p=0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors.Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

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Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series*

Journal of International Medical Research ◽

10.1177/0300060517724931 ◽

2017 ◽

Vol 46 (1) ◽

pp. 316-325 ◽

Cited By ~ 3

Author(s):

Chuandi Zhou ◽

Qiurong Lin ◽

Yuxin Wang ◽

Qinghua Qiu

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Success Rates ◽

Pneumatic Retinopexy ◽

The Mean ◽

Final Operation

Objective To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD). Methods Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA). Results In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40. Conclusions Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

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Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2018/9016302 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ritesh Shah ◽

Raghunandan Byanju ◽

Sangita Pradhan ◽

Sudha Ranabhat

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Techniques ◽

Scleral Buckling ◽

Correct Selection ◽

Success Rates ◽

Scleral Buckle ◽

Preoperative Visual Acuity ◽

Anatomical Success

Introduction. Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method. Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results. A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion. Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

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Advanced Vitrectomy Surgery in Rhegmatogenous Retinal Detachment; Indications and Techniques

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0166 ◽

2019 ◽

pp. 205-210

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Surgical Techniques ◽

Scleral Buckling ◽

Treatment Modalities ◽

Success Rates ◽

Retinal Tears ◽

Pars Plana ◽

Anatomical Success ◽

Vitrectomy Surgery

The main goal in the treatment of rhegmatogenous retinal detachment (RRD) is the localization of retinal tears, removal of tractions, and closure of retinal tears. Despite the use of pneumatic retinopexy, scleral buckling, and vitrectomy as standard treatment modalities, the preference for pars plana vitrectomy (PPV) in the treatment of RRD has increased steadily in recent years. The reason for this increase is the widespread use of small-sized transconjunctival surgery, improvement of bimanual surgery, use of liquid perfluorocarbons, improved vitrectomy devices and more safe and successful removing of peripheral vitreous bases, visualization of membranes with vital dyes, safe retinopexy with use of curved laser probe even with phakic cases. Besides these, PPV and advanced surgical techniques are more needed in complicated detachments. Nevertheless, the surgeon has a specially important role in the surgical technique of choice. Although the control of the procedures can be performed much more successfully with the PPV in the case of complicated RRD patients during surgery, anatomical success rates are still not very high. In this article, the applications of advanced vitrectomy surgery in RRD are discussed in detail.

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Outcomes of Rhegmatogenous Retinal Detachment

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1073 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Sidrah Riaz ◽

Muhammad Tariq Khan ◽

Khurram Azam Mirza

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Success Rates ◽

Cross Sectional ◽

Pars Plana ◽

Anatomical Success ◽

Anatomical Success Rate

Purpose: To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore. Study Design: Cross sectional Observational study. Place and Duration of Study: Private Vitreo-retinal setup, from March 2017 to April 2019. Methods: Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months. Results: Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up. Conclusion: Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world. Key Words: Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.

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