| Object:To identify risk factors affecting visual outcomes and re-detach after initial retinal detachment surgery in inferior rhegmatogenous retinal detachment.To study the choice of reoperation re-detach after initial retinal detachment surgery Method:Retrospective analysis of 121 cases of inferior rhegmatogenous retinal detachment.Patients with inferior rhegmatogenous retinal detachment received surgical treatment in Ophthalmology Center the Second Hospital of Jilin University during January 2015 to December 2019.The age range was between 15 and 74 years.Mean age was 42.57±15.87 years,59 cases were male and 62 cases were female.According to the methods of operation,the patients were divided into the SB group and the PPV group.The SB group included 66 eyes and the PPV group included 55 eyes.Data extracted were basic information,number of retinal breaks,quadrants of retinal detachment,macula status(on/off),PVR grading,anatomic outcome of surgery,preoperative and postoperative snellen best-corrected visual acuity(BCVA),preoperative and postoperative IOP,postoperative complications,type of reoperation.To identify risk factors affecting visual outcomes and re-detach after initial retinal detachment surgery in inferior rhegmatogenous retinal detachment surgery.To study the choice of reoperation re-detach after initial retinal detachment surgery.Result:In 121 eyes,98 eyes with initial retinal reattachment,and 121 eyes with final retinal reattachment.Scleral buckling surgery was used for the primary repair of inferior rhegmatogenous retinal detachments in 66 cases and it was successful in 57cases(86.4%),the final retinal anatomical reposition was successful.55 cases underwent vitrectomy with internal silicone oil tamponade.Anatomical success was obtained in 41 cases(74.5%).The final retinal anatomical reposition was successful.In both the groups,mean BCVA improved significantly postoperatively: in SB group,from 0.91±0.68 Log Mar to 0.29±0.31 Log Mar(P < 0.001).In PPV group,from pre-operative 1.36±0.69 Log Mar to 0.70±0.58 Log Mar(P<0.001).Unitary linear recursive analysis results showed that Duration of symptoms(P=0.045),macula status(on/off)(P=0.001),preoperative BCVA(P < 0.001)and quadrants of retinal detachment(P=0.001)had a significant effect on BCVA following SB.Macula status(on/off)(P<0.001),preoperative BCVA(P<0.001)and quadrants of retinal detachment(P=0.001)had a significant effect on BCVA following PPV.Variables with P < 0.1 were analyzed by multiple linear regression,showed that preoperative BCVA(P=0.014),macula status(on/off)(P=0.017)had a significant effect on BCVA following SB.Preoperative BCVA(P < 0.001),quadrants of retinal detachment(P=0.002)and high myopia(P=0.031)had a significant effect on BCVA following PPV.Univariate logistic regression analyses showed that Duration of symptoms(P=0.015)and Preoperative BCVA(P=0.028)were potential risk factors for SB anatomical failure.Multivariable logistic regression analyses showed that Duration of symptoms were independent risk factors for SB recurrent detachment(P=0.032,OR=1.031,95%CI:1.003-1.060).According to the ROC analysis results,the threshold preoperative symptom duration was 47.5 days.Selection of reoperation methods: the retinal reattachment failed after initial surgery were 9 cases in SB group.6 cases selected SB surgery again,3 cases selected ppv surgery.The retinal reattachment failed after initial surgery were 11 cases in ppv group.11 cases selected ppv surgery again,3 cases selected SB surgery.Conclusion:1.Vitrectomy and scleral buckling obtained good visual acuity.2.Preoperative factors associated with the visual outcome after SB surgery were the preoperative BCVA and macula status(on/off).3.Preoperative factors associated with the visual outcome after PPV surgery were the preoperative BCVA,quadrants of retinal detachment and high myopia.4.Duration of symptoms were independent risk factors for SB recurrent detachment.The optimal cutoff value,which significantly increases inferior RRD recurrence,is 47.5 days.5.When reoperation for recurrent retinal detachment,the influence of multiple factors such as the cause of recurrence,time of recurrence,and initial operation method should be considered. |
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