Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Abstract

Purpose: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD).

Methods: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age.

Results: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003).

Conclusions: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Keywords: Age; Prognostic factor; Rhegmatogenous retinal detachment; Scleral buckling; Vitreous.

Fig. 1. Age of patients with rhegmatogenous retinal detachment. Data shows bimodal distribution with double peaks. Anatomical failure after primary scleral buckle surgery was observed more frequently in patients older than 35 years (p = 0.042).

Fig. 2. Case 1: typical fundus findings of a young patient with rhegmatogenous retinal detachment (less liquefied without posterior vitreous detachment, long symptom duration, better initial visual acuity, small retinal tear, lower visual recovery, and sustained subretinal fluid). A 20-year-old male visited Pusan National University Hospital complaining of decreased visual acuity of his left eye for more than 1 month. His best-corrective visual acuity was 20 / 200 in that eye. Fundus photo (left) shows shallow retinal detachment (white dotted line) with a small retinal hole (black line) and a subretinal strand. The retina was reattached after scleral buckling without any adjuvant procedure (upper right). His best-corrected visual acuity improved to 20 / 50 and optical coherent tomography (lower right) shows sustained subretinal fluid at 3 months after surgery.

Fig. 3. Case 2: typical fundus finding of an older patient with rhegmatogenous retinal detachment specified by liquefied with posterior vitreous detachment, short symptom duration, poor initial visual acuity, large retinal tear, better visual recovery, and needed subretinal fluid (SRF) drainage. A 60-year-old male visited Pusan National University Hospital complaining of sudden visual loss of his left eye 4 days ago. His best-corrected visual acuity was measured by counting finger in counting for that eye. Fundus photo (left) shows bullous retinal detachment (white dotted line) with a large tear of 1.0 disc diameter (black line). The retinal tear could not be settled on the retinal pigment epithelium by scleral protrusion. After SRF draining, the tear faced the pigment epithelium due to the buckle effect. His best-corrected visual acuity improved to 10 / 20 and there was no SRF on fundus photographs (upper right) or optical coherent tomography (lower right) 2 months after surgery.

Fig. 4. Theory of vitreous roles in rhegmatogenous retinal detachment. Less-liquefied vitreous (A) could play a role as a mechanical barrier like tamponade that blocks the passage of fluid through a break. However, liquefied vitreous with posterior vitreous detachment (B) can counteract the buckle effect.