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Researchers have identified a number of factors associated with good visual acuity (VA) outcomes in patients who underwent retinectomy during repair of rhegmatogenous retinal detachments (RD) with proliferative vitreoretinopathy (PVR), with the primary modifiable associated factor being earlier surgical intervention from the time of subsequent redetachment diagnosis. The findings were presented at the American Society of Retina Specialists 40th Annual Meeting, held in New York, July 13-16, 2022.
“Prior studies have identified preoperative VA, [silicone oil] tamponade duration, macular status, and retinectomy size as factors predictive of better outcomes following RD repair for PVR,” according to the researchers. “However, there are limited data comparing eyes with good visual outcomes to those with poor visual outcomes following retinectomy for RD repair.”
The researchers conducted a single-institution, interventional, retrospective, case-control study to investigate preoperative and intraoperative factors associated with good VA outcomes following RD repair for PVR that included retinectomy at the time of surgery. Patients who underwent surgery between January 1, 2015 and December 31, 2019 were eligible for the study.
The team grouped patients into 2 cohorts, a good VA cohort (VA ≥20/70) and an age- and gender-matched poor VA cohort (2:1; VA <20/70). They compared 25 demographic and clinical characteristics between the cohorts, including time from primary and recurrent RD diagnosis to surgery, lens status, initial RD size, macula involvement, PVR grade, and size of retinectomy. They collected best-available Snellen VA data from the post-operative 1-month, 3-month, 6-month, 12-month, and final visits.
A total of 5355 eyes were diagnosed with primary RD, and of those, 345 had PVR and underwent retinectomy. The good VA cohort comprised 62 eyes and had a mean final logMAR VA of 0.32 (Snellen 20/42); the poor VA cohort comprised 119 eyes and had a mean final logMAR VA of 1.54 (Snellen 20/693; P <.0001). Among the groups, patients had similar mean ages (62±10 years) and proportions of men and women (approximately 70% and 30%, respectively).
Based on univariate analysis, the researchers selected 12 clinically and statistically significant metrics for inclusion in a multivariate logistic regression analysis: age, gender, size of initial RD, extent of initial retinectomy, retinectomy during initial surgery, number of overall surgeries, pre-operative VA, macula status at presentation and subsequent surgeries, time to subsequent surgeries, final lens status, and final silicone oil status.
Using multivariate analysis accounting the above factors, the researchers found that smaller RD size (P <.0090), better preoperative VA (P <.0276), decreased time between RD diagnosis and repair (P <.0006), fewer reoperations (P <.0002), and pseudophakia (P <.0049) were correlated with better VA outcomes.
They also found that eyes that achieved good VA had fewer days between recurrent RD diagnosis and repair than eyes with worse VA (mean, 2.9 vs 5.8 days; P <.0012), regardless of macula status, and a shorter time to surgery when gas tamponade had been used at the prior surgery (1.2 vs 4.3 days; P <.0047) than when oil was present (5.9 vs 7 days; P <.7029).
“This study demonstrates that performing a retinectomy does not preclude patients from achieving good vision following repair of RDs with PVR,” concluded the researchers. “Even in the setting of PVR, earlier surgical intervention from the time of subsequent re-detachment diagnosis particularly in the absence of [silicone oil] tamponade may help to achieve better functional outcomes.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Ghiassi M, Wagner BD, Palestine AG, Mandava N, Lynch AM. Factors associated with good visual acuity outcomes after retinectomy in eyes with proliferative vitreoretinopathy. Poster presented at: The 40th annual American Society of Retina Specialists meeting; July 13-16, 2022; New York. Poster 339.
