Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

Sung Won Choi; Kwang Soo Kim; Yu Cheol Kim

doi:10.3341/jkos.2014.55.12.1808

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Choi, Kim, and Kim: Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

Original Article

J Korean Ophthalmol Soc 2014;55(12):1808-1813.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1808

Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age

Sung Won Choi, MD, Kwang Soo Kim, MD, Yu Cheol Kim, MD

Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Yu Cheol Kim, MD, Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea, Tel: 82-53-250-8026, Fax: 82-53-250-7705, E-mail: eyedr@dsmc.or.kr

Received 31 May 2014 Revised 7 October 2014 Accepted 17 November 2014

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 investigate the risk factors and the factors affecting surgical and visual outcomes of rhegmatogenous retinal detachment in patients under 40 years of age.

Methods

This retrospective study included 88 patients (96 eyes) diagnosed with rhegmatogenous retinal detachment that were followed up for more than 3 months postoperatively. Patients were categorized into 3 groups according to age. The etiologic risk factors and the primary anatomical and functional success rates were analyzed. Preoperative factors that could affect postoperative visual acuity and primary anatomical outcome, such as subretinal strands and proliferative vitreoretinopathy (grade C or worse), were analyzed.

Results

Myopia more severe than −4.0 diopters was the most common predisposing factor in all 3 groups. Anatomical success rates and functional success rates were not significantly different among the groups. Prevalence of macular detachment and proliferative vitreoretinopathy were highest in group 1. The presence of subretinal strands was highest in group 2 and proliferative vitreoretinopathy was highest in group 1. Patients with preoperative subretinal strands showed a lower primary anatomical success rate in group 1 and poor postoperative visual acuity in groups 1 and 2. Patients with proliferative vitreoretinopathy had poor postoperative visual acuity however there was no significant difference in primary anatomical success rate among the groups.

Conclusions

Proliferative vitreoretinopathy did not affect the anatomical success rate but did affect visual outcome in rhegmatogenous retinal detachment in patients under age 40. Subretinal strands contributed to a lower anatomical success rate and poorer visual outcome in such patients that were under age 18.

Keywords: Posterior vitreous detachment, Proliferative vitreoretinopathy, Rhegmatogenous retinal detachment, Subretinal strand

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Table 1.

Basic characteristics of patients

	Group 1 (n = 18)	Group 2 (n = 41)	Group 3 (n = 37)	p-value
Age (years)	13.78 ± 3.64	25.12 ± 3.96	35.65 ± 2.55
Sex (M:F)	14:4	20:21	22:15	0.111^*
Duration of symptoms (days)	66.22 ± 112.30	39.78 ± 94.43	62.81 ±122.79	0.230^†
BCVA at first visit (log MAR)	1.12 ± 0.77	0.86 ± 0.84	0.61 ± 0.87	0.012^†,^‡
BCVA at final visit (log MAR)	0.70 ± 0.81	0.51 ± 0.66	0.31 ± 0.56	0.087^†
Subretinal strands (%)	6 (33)	18 (43)	10 (27)	0.292^*
PVR (%)	14 (78)	14 (33)	13 (35)	0.004^*,^‡
Macula off (%)	13 (72)	19 (46)	13 (35)	0.035^*,^‡
Predisposing factor (%)
Myopia	10 (56)	27 (64)	23 (62)	0.062^*
Lattice degeneration in myopic eye	5 (50)	16 (59)	14 (61)	0.837^*
Trauma	1 (5)	2 (5)	1 (3)	0.845^*
Old RD	0 (0)	1 (2)	3 (8)	0.282^*
Uveitis	1 (5)	1 (2)	4 (11)	0.10^*
Refractive surgery	0 (0)	2 (5)	1 (3)	0.787^*
Cataract surgery	3 (17)	2 (5)	0 (0)	0.08^*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; log MAR = logarithm of the minimal angle of resolution; PVR = proliferative vitreoretinopathy; RD = retinal detachment.

^* Analyzed with chi-square test;

^† Analyzed with Kruskal-Wallis test;

^‡ p < 0.05 was considered to be significant.

Table 2.

Comparison of visual acuity according to subretinal strands and proliferative vitreoretinopathy

		Subretinal strands		p-value^*	PVR		p-value^*
		Positive	Negative	p-value^*	Positive	Negative	p-value^*
Group 1	Initial BCVA	1.98 ± 0.86	0.84 ± 0.51	0.042^†	1.23 ± 0.86	0.80 ± 0.32	0.517
Group 1	Last BCVA	1.70 ± 1.02	0.37 ± 0.37	0.004^†	0.88 ± 0.87	0.15 ± 0.19	0.047^†
Group 2	Initial BCVA	1.00 ± 0.87	0.74 ± 0.82	0.310	1.62 ± 0.80	0.46 ± 0.54	<0.001^†
Group 2	Last BCVA	0.77 ± 0.73	0.30 ± 0.52	0.005^†	1.04 ± 0.66	0.22 ± 0.46	<0.001^†
Group 3	Initial BCVA	0.74 ± 1.04	0.57 ± 0.82	0.553	1.15 ± 1.02	0.34 ± 0.65	0.002^†
Group 3	Last BCVA	0.23 ± 0.34	0.34 ± 0.62	0.974	0.62 ± 0.84	0.15 ± 0.22	0.011^†

Values are presented as mean ± SD.

BCVA = best-collected visual acuity; PVR = proliferative vitreoretinopathy.

^* Analyzed with Kruskal-Wallis test;

^† p < 0.05 was considered to be significant.

Table 3.

Distribution of patients according to operation methods and primary anatomical success rate according to age

		Buckle (%)			PPV (%)			PPV + buckle (%)	Primary success rate (%)
	SB	RB	EB	SF₆	C₃F₈	S-oil	No
Group 1	5 (28)	0	0	1 (6)	0	3 (17)	1 (6)	8 (44)	14 (78)
Group 2	27 (66)	6 (15)	0	1 (2)	2 (5)	0	0	5 (12)	36 (88)
Group 3	15 (41)	6 (16)	2 (5)	10 (27)	1 (3)	1 (3)	0	2 (5)	32 (86)
Total	47 (49)	12 (13)	2 (2)	12 (13)	3 (3)	4 (4)	1 (1)	15 (16)	82 (85)

PPV = pars plana vitrectomy; SB = segmental circumferential scleral buckleing; RB = radial scleral buckling; EB = encircling sclera buckling; SF6 = sulfur hexafluoride tamponade; C3F8 = octafluoropropane tamponade; S-oil = silicone oil tamponade.

Table 4.

Comparison of anatomical and functional outcomes

Primary success rate	Group 1 (n = 18)	Group 2 (n = 41)	Group 3 (n = 37)	p-value^*
Anatomical (%)	14 (78)	36 (88)	32 (86)	0.396
Functional (%)	8 (45)	24 (59)	26 (70)	0.175

^* Analyzed with chi-square test.

Table 5.

Anatomical and functional success rate according to initial operation (vitrectomy, scleral buckling and vitrectomy with scleral buckling)

	Buckle (n = 61)	PPV (n = 20)	PPV + buckle (n = 15)	p-value
Age (years)	28.00 ± 6.89	30.89 ± 8.74	18.88 ± 10.07	0.001^†,^‡
Primary anatomical success rate (%)	55 (90)	15 (75)	13 (87)	0.237^*
Primary functional success rate (%)	38 (62)	12 (60)	6 (40)	0.264^*
Pre-operative BCVA	0.45 ± 0.58	1.11 ± 1.03	1.28 ± 0.61	<0.001^†,^‡
Final BCVA	0.20 ± 0.34	0.44 ± 0.46	0.71 ± 0.55	<0.001^†,^‡