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Kwon, Shin, Park, Byon, Lee, and Oum: Prognostic Factors of Anatomical Success in Scleral Buckling for High Myopic Rhegmatogenous Retinal Detachment
Original Article

J Korean Ophthalmol Soc 2016;57(10):1586-1591.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1586

Prognostic Factors of Anatomical Success in Scleral Buckling for High Myopic Rhegmatogenous Retinal Detachment

Hanjo Kwon, MD1, Min Kyu Shin, MD1, Sung Who Park, MD1, 2, Ik Soo Byon, MD, PhD1, 3, Ji Eun Lee, MD, PhD1, 2, Boo Sup Oum, MD, PhD1, 2

1Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

2Medical Research Institute, Pusan National University Hospital, Busan, Korea

3Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Address reprint requests to Sung Who Park, MD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341 E-mail: oph97@naver.com

Received 26 May 2016       Accepted 18 September 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the prognostic factors associated with anatomical success of scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) in high myopia patients.

Methods

The medical records of RRD in highly myopic eyes treated with SB from January 2009 to December 2013 were reviewed retrospectively. Cases with history of intraocular surgery including phacoemulsification and vitrectomy were excluded. Correlations between anatomical success and the parameters of age, sex, preoperative visual acuity, axial length, presence of large tear, presence of horseshoe tear, the number of tears, involved fovea, and extent of detachment were analyzed.

Results

This study included 80 eyes of 80 patients. Average age and axial length were 32.3 ± 13.4 and 26.753 ± 0.961 mm, respectively. Sixty-nine eyes (86.3%) were reattached following primary surgery. Univariate analysis revealed that age (p = 0.011), presence of large tear (p = 0.002), and presence of horseshoe tear (p = 0.044) were correlated with anatomical success after SB. Based on multivariate logistic regression analysis, age was the sole independent prognostic factor (odds ratio = 1.086, 95% confidence interval = 1.022∼1.154, p = 0.004).

Conclusions

A younger age is associated with a higher rate of primary anatomical success of SB for RRD in highly myopic eyes. In young, highly myopic patients with RRD, SB should be considered as the primary procedure.

Keywords: Anatomical success, High myopia, Prognostic factor, Rhegmatogenous retinal detachment, Scleral buckle

References

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Table 1.
Baseline characteristics and surgical outcomes
Factors Value
Total eyes 80
Success rate (%) 86.3 (69/80)
Mean axial length (mm) 26.753 ± 0.961
Mean age (years) 32.3 ± 13.3
Mean preoperative VA (log MAR) 0.77 ± 0.78
Mean postoperative VA (log MAR) 0.33 ± 0.35
Involved fovea (n, %) 48 (60.0)
Presence of large tear* (n, %) 36 (45.0)
Presence of horseshoe tear (n, %) 28 (35.0)
The number of breaks 1.9 ± 1.9
The range of RD (hour) 4.96 ± 2.33
Segmental buckling/Encircling (n, %) 69 (86.3)/11 (13.7)
Subretinal fluid drainage (n, %) 27.5 (22/80)

Values are presented as mean ± SD or n (%) unless otherwise indicated.

VA = visual acuity; RD = retinal detachment.

* A large tear was defined as a tear with the largest dimension more than 0.5 disc diameter.

Table 2.
Factors affecting anatomical success with univariate and multivariate logistic regression analysis
Factors Anatomical failure Anatomical success Univariate p-value* Multivariate p-value†
Eye (OD/OS) (n, %) 6 (54.5)/5 (45.5) 31 (44.9)/38 (55.1) 0.746 0.451
Axial length 27.4 ± 1.2 26.6 ± 0.9 0.130 0.058
Age (years) 42.9 ± 8.5 30.6 ± 13.2 0.011 0.004
Preoperative VA (log MAR) 0.86 ± 0.85 0.76 ± 0.78 0.869 0.427
Postoperative VA (log MAR) 0.44 ± 0.34 0.32 ± 0.35 0.837 0.582
Fovea On/Off (n, %) 4 (36.4)/7 (63.6) 28 (40.6)/41 (59.4) 1.000 0.796
Without/With large tear‡ (n, %) 1 (9.1)/10 (90.9) 43 (62.3)/26 (37.7) 0.002 0.163
Without/With horseshoe tear (n, %) 4 (36.4)/7 (63.6) 48 (69.5)/21 (30.4) 0.044 0.452
The number of breaks 2.01 ± 2.03 1.27 ± 0.90 0.135 0.276
Range of RD (hour) 4.9 ± 1.8 5.0 ± 2.4 0.655 0.651
Segmental buckling/Encircling (n, %) 11 (100.0)/0 (0.0) 58 (84.1)/11 (15.9) 0.346 0.143
Subretinal fluid drainage (n, %) 4 (36.4)/7 (63.6) 18 (26.1)/51 (73.9) 0.483 0.215

Values are presented as mean ± SD unless otherwise indicated.

OD = oculus dexter; OS = oculus sinister; VA = visual acuity; RD = retinal detachment.

* Univariate binary logistics regression analysis

† Multivariate binary logistics regression analysis

‡ A large tear was defined as a tear with the largest dimension more than 0.5 disc diameter.

Table 3.
Aging effect on preoperative and postoperative factors
Factors Correlation coefficient p-value*
Axial length (mm) –0.100 0.378
The number of tear (n) –0.007 0.948
Preoperative VA (log MAR) 0.315 0.004
Postoperative VA (log MAR) 0.147 0.192
Detachment area (hour) 0.203 0.071

VA = visual acuity.

* Pearson correlation analysis.

Table 4.
Aging effect on intraoperative and postoperative factors
Factors Average p-value†
Anatomical success/Failure 34.2 ± 13.5/34.2 ± 13.5 0.011
Fovea On/Off 34.2 ± 13.5/29.4 ± 12.6 0.406
Without/With Large Tear* 25.2 ± 9.0/41.0 ± 12.5 0.008
Without/With horseshoe tear 27.9 ± 10.7/40.6 ± 13.7 0.001
Segmental buckling/Encircling 29.5 ± 15.2/32.7 ± 13.1 0.661
With/Without SRF drainage 32.8 ± 14.2/30.8 ± 10.8 0.207

Values are presented as mean ± SD unless otherwise indicated.

SRF = subretinal fluid.

* A large tear was defined as a tear with the largest dimension more than 0.5 disc diameter

† Mann Whitney-U test.

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