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Outcomes and complications associated with giant retinal tear management using perfluoro-n-octane
Ingrid U Scott1, Timothy G Murray, Harry W Flynn
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Objective:
To report visual acuity and anatomic outcomes, as well as complications, associated with giant retinal tear management using intraoperative perfluoro-n-octane and to investigate clinical features associated with anatomic and visual acuity outcomes.
Design:
A prospective, noncomparative, observational, multicenter study.
Participants:
Two hundred twelve patients (212 eyes) > or =15 months of age who underwent giant retinal tear management with intraoperative perfluoro-n-octane at 24 study sites between April 1994 and February 1996. Giant retinal tear was defined as a retinal tear extending > or =90 degrees.
Intervention:
Vitrectomy with perfluoro-n-octane intraoperative retinal tamponade.
Main Outcome Measures:
Visual acuity and rates of retinal reattachment, reoperation, retained perfluoro-n-octane, corneal edema, elevated intraocular pressure (IOP > 25 mmHg), hypotony (IOP < 5 mmHg), and cataract. All outcome measures were assessed at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively and at the last examination.
Results:
The study included 212 eyes of 212 patients followed a median of 3.5 months. Visual acuity > or =20/200 was measured in 56 (27%) patients preoperatively and 67 (47%) patients at 6 months. Postoperative visual acuity improved in 107 (59%) eyes, remained stable in 44 (24%) eyes, and worsened in 29 (16%) eyes (percentages are based on the number of patients for whom the data were available at these time points). Of the 124 patients with visual acuity < or =5/200 preoperatively, 94 (76%) had improved visual acuity at 6 months postoperatively. At 6 months, the retina was attached in 108 (76%) eyes, and retained perfluoro-n-octane was noted in 8 (6%) eyes. Throughout follow-up, 64 (30%) eyes underwent reoperation for recurrent retinal detachment. At 6 months, corneal edema, elevated IOP, and hypotony were noted in 5 (4%), 4 (3%), and 12 (9%) eyes, respectively. Of the 72 phakic eyes without cataract preoperatively, 61 (85%) had a cataract or underwent cataract extraction during study follow-up. Factors significantly (P < 0.05) associated with recurrent retinal detachment include female gender, younger age, preoperative proliferative vitreoretinopathy, prior vitrectomy, larger size of giant retinal tear, lack of scleral buckle placement, and relaxing retinotomy. Multivariate analysis demonstrated that female gender, larger size of giant retinal tear, and prior vitrectomy were significantly associated with recurrent detachment. Factors significantly associated with vision >or =20/200 include male gender, no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy. After adjusting for recurrent detachment, factors significantly associated with vision > or =20/200 include no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy.
Conclusions:
Retinal reattachment and preserved visual acuity were achieved in most eyes that underwent giant retinal tear management with intraoperative perfluoro-n-octane. Significant risk factors for recurrent retinal detachment include size of retinal tear, age, prior vitrectomy, and female gender. After adjusting for recurrent detachment, significant predictors of postoperative vision >or =20/200 include no prior vitrectomy, better preoperative vision, and no need for relaxing retinotomy.