Analysis Of Related Factors Influencing The Efficacy Of Vitreous Surgery For Rhegmatogenous Retinal Detachment Associated With Choroidal Detachment

Objective:To investigate the factors influencing the efficacy of vitrectomy combined with intraocular silicone oil filling in the treatment of rhegmatogenous retinal detachment associated with choroidal detachment(RRDCD).Methods:This was a retrospective study of 85 patients(85 eyes)with RRDCD treated in the Department of Ophthalmology,The Second Hospital of Jilin University from January 2013 to May 2018.The factors analyzed included age,gender,eye,course of disease,preoperative visual acuity,intraocular pressure(IOP)and PVR grade,use of steroids,range and severity of choroidal detachment,range of retinal detachment,location,number and size of retina tears,lens status,whether there were complications of high myopia and macular holes,postoperative use of steroids.Results:In this group,the rate of retinal reattachment after initial surgery(77.6%),and the rate of final visual acuity above 0.05(35.3%)were all significantly lower than those of the patients with rhegmatogenous retinal detachment(RRD).The retinal reattachment rate after primary surgery was 91.7% in patients with grade-C1 to C3 PVR,and 59.5% in patients with grade-D1 to D3 PVR.For patients with grade-C PVR or above,the more severe the PVR,the lower the primary surgical reattachment rate.The retinal reattachment rate of patients with preoperative IOP lower than 10 mmHg and above 10 mmHg was 64.7% and 97.1% respectively.The reattachment rate after initial surgery was low in patients with low preoperative IOP.Preoperative periocular steroid injections and the oral administration of steroids could control inflammation to a certain extent and the rate of retinal reattachment in the two groups after primary surgery was 78.4% and 76.5% respectively,with no significant difference.68.4% of the cases of retinal re-detachment after surgery were caused by PVR recurrence,and continued oral administration of steroids after surgery could not prevent the occurrence of postoperative PVR.After vitreous surgeries,the visual acuity of the patients in this study was significantly improved,but the overall visual acuity of the patients was low.Preoperative visual acuity was an effective index to estimate the postoperative visual acuity.Conclusion:1.The more severe the preoperative PVR,the lower the rate of RRDCD retinal reattachment after primary vitreous surgeries.2.The lower the preoperative IOP,the lower the rate of RRDCD retinal reattachment after primary vitreous surgeries.3.Preoperative periocular steroid injections and oral administration of steroids for RRDCD have no difference in the rate of retinal reattachment after primary vitreous surgeries.4.The occurrence of postoperative PVR is the main cause of retinal re-detachment,and continued oral administration of steroids cannot control the occurrence of PVR effectively.5.Vitrectomy is an effective method to treat RRDCD,but the overall postoperative visual acuity of patients is low;and preoperative visual acuity is an effective indicator to estimate the postoperative one.