Missed retinal breaks in rhegmatogenous retinal detachment

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vitreoretinal Diseases

Background:

• Rhegmatogenous retinal detachment (RRD) is a serious condition requiring prompt surgical intervention.
• Missed retinal breaks (MRBs) and inaccurate assessment of posterior vitreous detachment (PVD) can complicate RRD management.
• Understanding the factors associated with MRBs and PVD is crucial for improving surgical outcomes.

Purpose of the Study:

• To investigate the causes and associations of missed retinal breaks (MRBs) in patients diagnosed with rhegmatogenous retinal detachment (RRD).
• To evaluate the prevalence and diagnostic accuracy of posterior vitreous detachment (PVD) in RRD patients.
• To identify clinical features associated with MRBs and PVD during vitreo retinal surgery.

Main Methods:

• Retrospective analysis of case sheets from patients undergoing vitreo retinal surgery for RRD.
• Inclusion of 253 patients for MRB analysis and 191 for PVD analysis based on defined criteria.
• Comparison of pre-operative examination findings with intra-operative findings to identify MRBs and assess PVD status.

Main Results:

• 27% of RRD patients had MRBs, commonly associated with lattice degeneration or complete PVD.
• Pseudophakia (post-cataract surgery) significantly increased the odds of MRBs (Odds Ratio 1.91).
• Advanced proliferative vitreoretinopathy (PVR) and retinal bullae were primary reasons for missed breaks; PVD was present in 52% of cases, with pseudophakia and retinal bullae being strong associated factors.

Conclusions:

• Patients with pseudophakia, retinal bullae, or advanced PVR require meticulous screening for MRBs.
• While Weiss ring is indicative of PVD, its diagnosis can be overestimated in some instances.
• PVD is associated with retinal bullae and pseudophakia, and inversely correlated with traumatic RRD.