A recent study found that reoperation after primary rhegmatogenous retinal detachment (RRD) was necessary in nearly 20% of patients. The study examined associations between primary repairs, patient characteristics and RRD reoperation rates from insurance claims between 2003 and 2016. Patients with fewer than three years of continuous enrollment were excluded, as were those who had undergone previous RRD diagnosis or repair.
The team’s analysis of 16,190 patients with documented RRD repair showed that 2,918 (18%) required reoperation within 90 days. This rate was significantly associated with male sex, pseudophakic status, vitreous hemorrhage and worse systemic health. Across the board, pseudophakia resulted in higher reoperation odds after all primary procedures, except pars plana vitrectomy (PPV).
For RRD repair, cases requiring reoperation were as follows: 28.7% were pneumatic retinopexy cases, 19.1% were scleral buckling procedures and 17.9% were vitrectomy repairs. When adjusting for other patient characteristics, pneumatic retinopexy had the highest reoperation odds while primary laser barricade had the lowest odds of reoperation. The researchers noted that cases requiring only primary laser barricade likely represented the less severe RRDs. Vitrectomy was the most common reoperation procedure required.
“These findings may indicate differences in inherent procedure success rates, but may also reflect factors such as appropriate case selection,” the authors wrote in their paper. “Surgeons may be more likely to perform primary PPV for pseudophakic patients or in cases needing better visualization of small anterior peripheral retinal breaks, and may be more likely to choose scleral buckling for younger patients or in cases needing stabilization of the vitreous base. These decisions will inherently optimize the success of each procedure. Surgeon experience and comfort may also contribute.”
The investigators concluded these results are important to consider for surgical decision-making and patient education on likelihood of primary surgical success.
Reeves MR, Afshar AR, Pershing S. Need for retinal detachment reoperation based on primary repair method among commercially-insured patients, 2003-2016. Am J Ophthalmol. April 21, 2021. [Epub ahead of print].