An analysis of the outcomes for patients with failed primary vitrectomy for rhegmatogenous retinal detachment

Our aim was to identify the timing of retinal redetachments and the prognosis for affected patients.

Retrospective review of electronic patient records and casenotes from two centres. Inclusion criteria were failed primary vitrectomy for rhegmatogenous retinal detachment during a 12-year period. Failure was defined as re- or persistent detachment of the retina prior to a further procedure or at final follow-up.

The records of 133 cases of failed primary PPV for RRD were analysed. The mean age at time of primary surgery was 62.9 years, and mean follow-up was over 3 years from the date of primary surgery. In 72.9 % of cases, the redetachment was diagnosed within 2 months of the primary surgery. Eighty-five percent were diagnosed within 3 months, 89.5 % within 4 months, and 97.7 % within 6 months. For patients in whom the primary surgery had failed, the rates of attached retina at final follow-up were 80.5 %, or 68.8 % if PVR B/C were present at the time of primary surgery. The final follow-up success rates (attached retina with no tamponade) were 66.2 % for all patients, and 59.4 % for the subset with PVR B/C at the time of primary surgery respectively. Of the total, 33.8 % had one further vitreoretinal procedure, 30.8 % two more, 25.6 % three more, and 5.3 % had four or more. Visual outcome was better with final success (attached retina and no tamponade, p < 0.0001) and worse with PVR B/C evident on diagnosis of failed primary surgery (p < 0.0001).

A short duration of follow-up can over-estimate surgeon success rates for retinal detachment repair. For patients in whom primary surgery has failed, the prognosis for ultimate success is markedly lower than for primary surgery, and most patients require two or more further procedures to achieve this.