Abstract

DO.06.03

Dependence of functional outcome 1 year after retinal detachment surgery and the pre- and intraoperative findings as prognostical factors

Feltgen N.¹, Walter P.², Hoerauf H.³, Heimann H.⁴, Hilgers R. D.⁵, Heussen N.⁵ für die SPR Studien Gruppe
¹Universitäts-Augenklinik Freiburg; ²Universitäts-Augenklinik Aachen; ³Universitäts-Augenklinik Göttingen; ⁴St.Paul's Eye Unit University Hospital Liverpool; ⁵Institut für Medizinische Statistik Universität Aachen

Objective: The SPR-Study is a randomised multicentre clinical trial to compare the efficacy of scleral buckling surgery versus primary vitrectomy in the treatment of rhegmatogenous retinal detachments (RRD) with medium complexity. The study had two subtrails (phakic and pseudophakic/aphakic). The aim of the investigation was, to analyse the potential effect of predisposing and intraoperative findings on the best corrected visual acuity (BCVA) at 12 months visit.
Methods: Pre- and intraoperative dataset of 680 patients could be analysed. All patients have been recruited to the study between 1998 and 2003. We evaluated the intraoperative findings based on the fundus drawings and surgical report of the all patients. The evaluation was performed by three ophthalmologists on the basis of a majority vote. Using an univariate analysis we tried to define the main prognostical factors.
Results: The analysis of the phakic subtrial gave a reduced BCVA in older patients (p=0.0197), in eyes with reduced BCVA before surgery (p=0.0001), RRDs with an inferior nasal location (p=0.0122), RRDs with inferior temporal location (p=0.0012), RRDs with macula off (p<0.0001), RRDs with an elevated retinal flap (p=0.0325) and cataract (p=0.016). Concerning the surgical technique the intraoperative use of laser (p=0.0149) and the use of gas/air tamponade (p=0.025) were correlated to a reduced final BCVA. In the pseudophakic subtrial we found a reduced final VA in older patients (p=0.0044), in eyes with reduced VA before surgery (p<0.0001), RRDs with inferior temporal (p=0.001) and temporal superior location (p=0.0036). Concerning the surgical technique the intraoperative use of laser (p=0.0043) and the area of laser treatment (p=0.0143) as well as the area of cryotherapy (p=0.0244) and the drainage of subretinal fluid (p=0.0011) were correlated to a reduced final BCVA.
Conclusions: From the univariate analysis the main prognostical factors for the final VA in eyes with a medium severe RRD as defined by the SPR-Study Group seem to be patients’ age, the preoperative BCVA and the location of the detached area. The results of the subsequent multivariate analysis will evaluate the concurrence of the different factors.

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