Surgical outcome and risk stratification for primary retinal detachment repair: results from the Scottish Retinal Detachment study
- D Mitry1,2,
- M A Awan3,
- S Borooah1,
- M A Rehman Siddiqui4,
- K Brogan5,
- B W Fleck1,
- A Wright2,
- H Campbell2,
- J Singh1,
- D G Charteris6,
- D Yorston3
- 1Princess Alexandra Eye Pavilion, Edinburgh, UK
- 2Department of Public Health Sciences, University of Edinburgh, Edinburgh, UK
- 3Gartnavel General Hospital, Glasgow, UK
- 4Aberdeen Royal Infirmary, Abderdeen, UK
- 5Ninewells Hospital, Dundee, UK
- 6Moorfields Eye Hospital, London, UK
- Correspondence to Dr Danny Mitry, Clinical Research Fellow in Ophthalmology, Department of Public Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK;
Contributors Case recruitment—DM, MAA, SB, MAR, KB. Study design—DGC, JS, DY, BWF. Funding application—HC, DGC, DM, AW, BWF, JS. Data compilation—DM, MAA, SB, MAR. Data analysis—DM, DY. Writing the manuscript—DM, DY. Senior advice—DGC, HC, AW. Statistical advice—DY, JS, DGC.
- Accepted 7 December 2011
- Published Online First 18 January 2012
Objectives To report the early surgical outcome, risk of failure and predictive value of rhegmatogenous retinal detachment (RRD) classification based on all participants in the Scottish Retinal Detachment study.
Methods Over 2 years, all incident cases of RRD in Scotland were approached for recruitment. Early postoperative success was defined as an attached retina following one procedure with a minimum follow-up of 6–8 weeks. Using a regression model, the influence of clinical factors on the failure risk was estimated and the sensitivity and specificity of the Royal College of Ophthalmologists (RCOphth) grading for RRD and the vitrectomy in retinal detachment stratification risk formula (VR-SRF) in predicting operative failure were assessed.
Results Primary outcome data were available for 86.2% (975/1130) of patients. The overall primary success rate was 80.8% (95% CI 78.1 to 83.3%). The presence of preoperative proliferative vitreoretinopathy of any degree and each additional clock hour of detachment increased the risk of failure by an OR of 2.4 and 1.13 respectively (p<0.05). A specificity of >95% in predicting early surgical failure was noted for highly complex RRDs according to the VR-SRF formula and the RCOphth classification.
Conclusions Consistent with previous series, the overall early success rate of RRD repair was 80% after one operation. The type of surgical repair did not influence overall success rates. Significant predictors of failure are the presence of preoperative proliferative vitreoretinopathy of any grade and the extent of detachment. The analytical value of current classification systems in predicting failure is most useful in complex RRDs.
- retinal detachment
- posterior chamber
- lens and zonules
- eye (globe)
- public health
- diagnostic tests/investigation
- clinical trial
- treatment surgery
- paediatric ophthalmology
- proliferative vitreoretinopathy
- vitreoretinal surgery
- blindness prevention in developing countries
- African ophthalmology
- eye care delivery in third world
No author has any financial or proprietary interest in any product mentioned.
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).
Competing interests None.
Patient consent Obtained.
Ethics approval Multi Centre Research and Ethics Committee Scotland.
Provenance and peer review Not commissioned; externally peer reviewed.