Analysis of Risk Factors for the Outcome of Primary Retinal Reattachment Surgery in Phakic and Pseudophakic Eyes

Markus Halberstadt; Lucia Brandenburg; Nathalie Sans; Ursula Koerner-Stiefbold; Fritz Koerner; Justus G. Garweg

doi:10.1055/s-2003-38189

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2003; 220(3): 116-121
DOI: 10.1055/s-2003-38189

Klinische Studie

Analysis of Risk Factors for the Outcome of Primary Retinal Reattachment Surgery in Phakic and Pseudophakic Eyes

Risikofaktoren für den Erfolg der primären Amotiochirurgie an phaken und pseudophaken AugenMarkus Halberstadt¹ , Lucia Brandenburg¹ , Nathalie Sans¹ , Ursula Koerner-Stiefbold¹ , Fritz Koerner¹ , Justus G. Garweg¹

¹Department of Ophthalmology, University of Bern, Inselspital, Bern, Switzerland (Director: Prof. Dr. med. F. Körner)

Abstract

Zusammenfassung

Hintergrund: Ziel der vorliegenden Studie war der Vergleich der prä-, intra- und postoperativen Situation in phaken und pseudophaken Augen mit frischer Amotio retinae, um ein Risikoprofil für den Operationserfolg nach primärer Amotiochirurgie zu erstellen. Patienten und Methoden: 220 konsekutive Patienten mit primärer Amotio retinae, 165 phake und 55 pseudophake Augen wurden einer Buckelchirurgie (Plombe/Cerklage) allein oder in Kombination mit einer Vitrektomie unterzogen. Prä-, intra- und postoperative Risikofaktoren wurden erfasst und deren Einfluss auf das anatomische und funktionelle Resultat mittels einer multivariaten Regressionsanalyse verglichen. Ergebnisse: Die kumulativen anatomischen Erfolgsraten nach 6 Monaten waren in phaken (88,5 %) und pseudophaken (86,3 %) Augen gleich (log rank = 0,340). Die Amotioausdehnung erwies sich in pseudophaken Augen als ein stärkerer Risikofaktor für die Beeinträchtigung des operativen Erfolges als in phaken Augen (p = 0,035). Bei phaken Augen zeigte sich kein Einfluss der Amotioausdehnung auf das chirurgische Resultat (1 Quadrant vs. 4 Quadranten; log rank = 0,135); während bei Pseudophakie eine Beeinträchtigung der Amotioausdehnung auf das chirurgische Resultat nachweisbar war (1 Quadrant vs. > 4 Quadranten; log rank < 0,001). Das relative Risiko einer Reamotio nach operativer Versorgung einer Amotio retinae ab 3 Quadranten betrug bei Normophakie 1,22 (CI: 0,71 - 1,70) und bei Pseudophakie 1,81 (CI: 0.88 - 2,59). Schlussfolgerungen: Bis zu einer Amotioausdehnung von 3 Quadranten weisen phake und pseudophake Augen ähnliche chirurgische Erfolgsraten auf. Ab einer Ausdehnung der Amotio retinae größer als neun Stunden findet sich im pseudophaken Auge, im Gegensatz zum phaken Auge, bei alleiniger eindellender Operation ein negativer Einfluss der Amotioausdehnung auf den Operationserfolg. Dieser kann durch ein kombiniertes extra- und intraokulares Vorgehen mit Vitrektomie reduziert werden.

Abstract

Background: To compare the preoperative risk profiles of phakic and pseudophakic eyes with primary retinal detachment and to assess their impact on the outcome of primary reattachment surgery. Patients and methods: 220 consecutive patients with primary retinal detachment, 165 phakic and 55 pseudophakic eyes were operated with scleral buckling alone or additional vitrectomy and followed up for 6 months. Pre-, intra- and postoperative risk factors were recorded and their impact on anatomical outcome after primary surgery in phakic and pseudophakic eyes was then compared in a multivariate regression analysis. Results: The cumulative probability of anatomical success 6 months after surgery was similar in phakic (88.5 %) and pseudophakic eyes (86.3 %; log rank = 0.340). The most important risk factor for a different surgical outcome between phakic and pseudophakic eyes was the size of retinal detachment (p = 0.035). In phakic eyes the size of retinal detachment had no significant impact on surgical outcome (1 vs. 4 quadrants; log rank = 0.135); whereas in pseudophakic eyes a significant impairment on surgical outcome was found (1 vs. 4 quadrants; log rank < 0.001). The relative risk for failure of primary surgery due to retinal detachment of at least 3 quadrants was in phakic eyes 1.22 (CI: 0.71 - 1.70), in pseudophakic ones 1.81 (CI: 0.88 - 2.59). Conclusions: The outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes is similar for retinal detachments up to 3 quadrants. In retinal detachments of more than 9 clock times, the size of retinal detachment impairs the surgical outcome in pseudophakic eyes more than in phakic ones. The combination of extraocular surgery with vitrectomy in pseudophakic eyes with retinal detachment of more than 9 clock times contributes to a better outcome.

Schlüsselwörter

Netzhautablösung - Normophakie - Pseudophakie - Risikofaktoren

Key words

Retinal detachment - surgical procedures - phakia, pseudophakia - risk factor, outcome assessment

Full Text

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Markus Halberstadt,MD

Dept. of Ophthalmology · Inselspital

3010 Bern · Switzerland

Email: markus.halberstadt@insel.ch