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Shin, Choi, and Kwon: Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment
Original Article

J Korean Ophthalmol Soc 2016;57(9):1378-1385.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.9.1378

Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment

Hyun Uk Shin, MD, Woo Seok Choi, MD, Yoon Hyung Kwon, MD

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Yoon Hyung Kwon, MD Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: 82-51-240-2776, Fax: 82-51-254-1987 E-mail: yhkwon@dau.ac.kr

Received 21 April 2016       Revised 12 July 2016       Accepted 22 August 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 investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD).

Methods

A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were mac-ula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated.

Results

In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ±0.55 log MAR, n = 16) (p = 0.008).

Conclusions

After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.

Keywords: Macular detachment, Rhegmatogenous retinal detachment, Visual acuity, Vitrectomy

References

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Figure 1.
Scatterplot illustrating the relation between postoperative 6 months best corrected visual acuity (BCVA, log MAR) and preoperative factors. (A) Preop BCVA is significantly correlated with postoperative 6 months BCVA in macula-off group (r = 0.313, p* = 0.037). In macula-on group, Preop BCVA is not significantly correlated with postoperative 6 months BCVA (r = 0.013, p = 0.953). (B) Preoperative retinal detachment (RD) extent (hours) is significantly correlated with postoperative 6 months BCVA in macula-off group (r = 0.483, p = 0.001). In macula-on group, Preoperative RD extent is not significantly correlated with postoperative 6 months BCVA (r = 0.318, p = 0.121). (C) Age (years) is not significantly correlated with postoperative 6 months BCVA in both group. (D) Duration of symptom (days) is not significantly correlated with postoperative 6 months BCVA in both group. (E) Delay of operation after clinic visit (hours) is not significantly correlated with postoperative 6 months BCVA in both group. I = Macular-off group; II = Macular-on group; Preop = preoperative; Postop = postoperative. * Statistically significance is p < 0.05; p-value was determined using linear regression analysis.
jkos-57-1378f1.tif
Table 1.
Clinical characteristics of patients
  Macula-off Macula-on p-value
Study population(n) 41 (41 eyes) 38 (38 eyes)  
Male:Female (n) 23:18 22:16 0.962*
Mean age (years) 48.8 ± 7.18 52.5 ± 11.74 0.215†
Phakic:Pseudophakic 21:20 18:20 0.671*
Preop BCVA (log MAR) 1.34 ± 0.67 0.34 ± 0.46 <0.001†
Mean RD extent (hours) 6.48 ± 3.00 3.61 ± 0.46 <0.001†
Duration of symptom (days) 4.85 ± 4.38 14.58 ± 27.84 0.045†
Delay of operation (after clinic visit, hours) 13.61 ± 13.65 13.32 ± 9.78 0.919†

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; RD = retinal detachment.

* Chi-square test

† Student t-test.

Table 2.
Comparison of change amount between preoperative BCVA and final BCVA according to cataract surgery
Group Phakic group‡ Pseudophakic group p-value*
Group I (n = 41) n = 21 n = 20  
 Preoperative BCVA 1.36 ± 0.66 1.31 ± 0.47 0.824
 Final BCVA 0.53 ± 0.57 0.44 ± 0.42 0.839
 △† 0.92 ± 0.86 0.81 ± 0.50 0.686
Group II (n = 38) n = 18 n = 20  
 Preoperative BCVA 0.34 ± 0.49 0.32 ± 0.31 0.618
 Final BCVA 0.21 ± 0.19 0.41 ± 0.73 0.230
 △† 0.12 ± 0.17 −0.08 ± 0.95 0.107

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; I = macula-off group; II = macula-on group.

* Statistically significance is p < 0.05; Mann-Whitney U-test

† Preop BCVA-Final BCVA

‡ All patients with phakic state underwent phacoe-mulsification & intraocular lens insertion with vitrectomy surgery.

Table 3.
The postoperative BCVA of patients based on duration of symptoms before vitrectomy repair of macula-off RRD
Group Number Average duration of symptom Post 6 m BCVA (log MAR) p-value
≤4 days 20 2.2 0.34 ± 0.42 0.019
5–60 days 25 29 0.64 ± 0.54  
≤5 days 24 2.63 0.37 ± 0.45 0.039
6–60 days 21 36.5 0.66 ± 0.56  
≤7 days 29 3.4 0.36 ± 0.45 0.008*
8–60 days 16 47.0 0.79 ± 0.55  
≤10 days 30 3.6 0.39 ± 0.45 0.017
11–60 days 15 49.8 0.76 ± 0.57  
≤14 days 30 4.3 0.41 ± 0.45 0.045
15–60 days 15 56.4 0.76 ± 0.61  

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; RRD = rhegmatogenous retinal detachment.

* Bonferroni correction for multiple testing was applied to adjust significant p-value at 0.01.

Table 4.
Postoperative complication of trans pars plana vitrectomy repair of rhegmatogenous retinal detachment
Complications Macula-off (%) Macula-on (%) n (%)
Epiretinal membrane 7 (17.07) 4 (10.52) 11 (13.92)
Proliferative vitreoretinopathy 3 (7.31) 1 (2.63) 4 (5.06)
Glaucoma 1 (2.43) 1 (2.63) 2 (2.53)
Vitreous hemorrhage 1 (2.43) 0 (0) 1 (1.26)
Total 12 (29.26) 6 (15.78) 18 (22.78)
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