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Retinal detachment repair by vitrectomy: simplified formulae to estimate the risk of failure
  1. L Wickham1,
  2. C Bunce1,
  3. D Wong2,
  4. D G Charteris1
  1. 1Vitreoretinal Department, Moorfields Eye Hospital, London, UK
  2. 2Vitreoretinal Department, The Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to L Wickham, VR Research Department, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; louisa.wickham{at}moorfields.nhs.uk

Abstract

Aim Devise simplified formulae, using preoperative clinical data, to give risk estimates of (1) failure and (2) proliferative vitreoretinpathy (PVR) following primary retinal detachment repair by vitrectomy.

Methods 641 patients were analysed as part of an RCT investigating use of 5-fluorouracil and low-molecular-weight heparin. Treatment status had no effect on success rates and did not therefore form part of the analyses. Preoperative risk factors for surgical failure and for PVR within 6 months of retinal detachment surgery were identified, and a multiple variable logistic regression model developed. Further analyses were performed to devise a simple points system to produce risk estimates of failure.

Results Three risk factors were related to failure—previous lens extraction (p=0.046), grade C PVR (p=0.039) and extent of detachment (p<0.001). Three risk factors were also related to failure due to PVR—vitreous haemorrhage (p=0.088), grade C PVR (p=0.044) and extent of detachment (p<0.001). There was good agreement between risk estimates produced by the points system and those calculated directly using a multivariate regression model. The points-system model gave an area under the receiver operating characteristic curve of 0.658. The receiver operating characteristic curve for the PVR model gave an area under the curve of 0.8399 suggesting greater diagnostic value.

Conclusions A simple points system may be used as a clinical guide to identify patients at higher risk of failure following retinal detachment repair by vitrectomy. This may help clinicians select appropriate surgical approaches and stratify cases in research and surgical training.

  • Retinal detachment
  • vitrectomy
  • failure
  • proliferative vitreoretinopathy
  • risk factors
  • formula
  • retina
  • treatment surgery

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Footnotes

  • Funding This study was supported by a major Ophthalmology grant from the Royal College of Surgeons Edinburgh, the Royal Blind School Edinburgh/Scottish War Blinded, the W.H. Ross Foundation for the Prevention of Blindness and the Chief Scientist Office Scotland (CZB/4/705). The authors acknowledge (a proportion of their) financial support from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Moorfields Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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