Outcomes of retinal detachment surgery at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Purpose: The aim of this study was to determine the visual acuity and anatomical outcome of retinal detachment repair at Charlotte Maxeke Johannesburg Academic hospital. Methods: Retrospective record review (clinical audit) of outcomes in patients who had retinal surgery (pars plana vitrectomy) for either rhegmatogenous retinal detachment or diabetic retinal detachment (tractional detachment or combined tractional and rhegmatogenous detachment) at Charlotte Maxeke Johannesburg Academic hospital during the period from 1 January 2010 to 31 December 2014. Results: During the specified time period 941 pars plana vitrectomies (including repeat surgery) were performed at the hospital. After exclusion for indications other than retinal detachment repairs and for missing or incomplete records, a total of 164 records of 164 patients were reviewed. The patients were divided into two groups: a rhegmatogenous retinal detachment group (n=99) and a diabetic retinal detachment group (n=65). Rhegmatogenous retinal detachment Ninety nine patients with rhegmatogenous detachment were included in the study, 62% male and 38% female. The mean age (± standard deviation) was 48(±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37 % and 21% of all causes respectively.

Sixty three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty three eyes (84%) obtained vision improvement or stabilization and retinal attachment. Forty eyes (40%) had visual acuity improvement, 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% (n=92) of eyes including those that needed a repeat surgery. Diabetic retinal detachment Sixty five patients with diabetic retinal detachment were included in the study. Sixty three percent (n=41) were males and the mean age (± standard deviation) was 54± 12.2 years. Sixty eight percent (n=44) had tractional retinal detachment and 32% (n=21) had a combined tractional and rhegmatogenous retinal detachment. Thirty two percent of patients had detachments associated with vitreous haemorrhage, and 60% had macular involving detachments. Forty six eyes (71%) obtained vision improvement or stabilization and attachment of the retina; 36.9% (n=24) had visual acuity improvement, 33.9% (n=22) retained the same visual acuity and 29.2% (n=19) lost vision. Eighty five percent (n=55) had successful anatomical reattachment of the retina and 15% (n=10) had re-detachments after surgery. Conclusions: This study found that the majority of patients, whose files were reviewed, benefited from surgical intervention for rhegmatogenous and diabetic retinal detachment in terms of stabilisation or improvement of vision. The major limitation of this study is the large number of missing or incomplete records. The results of this study are therefore not generalisable to our retinal detachment patient population.