Patient satisfaction and vision improvement after multiple surgery for recurrent retinal detachment

To assess patient satisfaction and functional status improvement after multiple surgery for recurrent retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C. Main outcome measures included visual acuity (VA), anatomic outcome, and patients' answers to a standardized multiple-choice questionnaire.

The authors retrospectively reviewed records of patients undergoing pars plana vitrectomy (PPV) for RRD with PVR grade C operated between 1997 and 1999. All included patients underwent a standardized telephone interview aimed at assessing the patients' visual performance and satisfaction. Statistical analysis used Wilcoxon signed-rank test, Mann-Whitney rank sum test, and Spearman rank correlation coefficient. p Values less than 0.05 were considered statistically significant.

The population study included 62 patients with an average 19+/-4.1 months follow-up. The average number of operations was 2.9+/-0.7 with 1.45+/-0.50 recurrences. At the end of the study, 40/62 eyes had better than 5/400 vision and 14/62 better than 20/200; 2 patients had no light perception and 5 eyes still had RRD. Questionnaire answers yielded the following results: 61% believed their VA was better than before surgery, 13% the same, and 26% worse. Fifty-two percent noticed an improvement in binocular vision versus 35% stable and 13% worse: 84% thought their result had been worth the operation, 15% did not, and 2% did not know. Ninety percent believed the information they received before surgery was accurate. Results exceeded expectations in 35% of cases and matched them in 26%. Increase in binocular visual performance after intervention was significant for clothing, bathing, and home deambulation, climbing steps, watching TV, and reading, but not for car driving. The difference in VA improvement in satisfied and unsatisfied patients was significant. There was no significant correlation between patients' satisfaction and fellow-eye vision.

The sample population showed a high rate of satisfaction and significant subjective improvement on four out of five tested activities, despite multiple surgeries and overall poor outcome, even in patients with a good VA in fellow eye. Many other factors such as visual field and contrast sensitivity improvement, not investigated by the authors, can play an important role in the visual functional status. Correct and extensive patient information remains critical in such settings.