gms | German Medical Science

Purpose: To evaluate the rate of redetachments in 252 consecutive patients with primary retinal detachments. Procedures were performed by four surgeons, vitrectomy, episcleral buckle procedures and combinations of both were first treatment regimen.

Methods: In a retrospective study the charts of 376 consecutive patients with primary rhegmatogenous retinal detachments were analyzed. 252 reached the inclusion criteria. All procedures were performed between January 01 and September 2002. Observation period was 3.5 years. Mean age of patients was 62.5 years, range from 28 to 76 years. Number and time of redetachments, type of intervention and identification of possible failures were categorized. In 59 eyes 20-gauge vitrectomy with endolasercoagulation and air, in 146 eyes episcleral buckle procedure with cryocoagulation and in 47 eyes combination of vitrectomy with encircling band without cryocoagulation was the first treatment regimen. No primary detachment required silicone oil.

Results: Overall rate of redetachment was identified in 21%, a third intervention was necessary in 6%. In eyes treated with episcleral buckle procedure with cryocoagulation 29% underwent a second procedure, in the vitrectomy group 38% were identified with retinal redetachment and in the combined procedure group 19% of redetachment was identified. The number of surgical procedures for each surgeon was 93, 59, 50 and 50 eyes, respectively. Number of redetachments varied from 20% up to 45% between the four surgeons. Statistic evaluation between different types of surgery for each surgeon revealed no significance but showed a distinct tendency for better results with vitrectomy combined with scleral buckling for two surgeons, whereas one surgeon showed the same rate of redetachment with all three types of surgery. Highestfailure rate was observed for unidentified holes and an unpredictable learning curve for different techniques.

Conclusion: Our findings demonstrate the importance of preoperative and postoperative identification of breaks and the need for guided surgery. It seems, that the most important factor for retinal detachment surgery is the surgeon, Further studies, evaluating vitrectomy, with and without trocarsystem are necessary.