The Predisposing Pathology and Clinical Characteristics in the Scottish Retinal Detachment Study

doi:10.1016/j.ophtha.2010.11.031

Ophthalmology

Volume 118, Issue 7, July 2011, Pages 1429-1434

https://doi.org/10.1016/j.ophtha.2010.11.031 Get rights and content

Purpose

To describe the predisposing pathology and clinical features of all incident cases of rhegmatogenous retinal detachment (RRD) recruited in Scotland during a 2-year period.

Design

Prospective surveillance study of incident cases of RRD.

Participants

All incident cases of RRD recruited as part of the Scottish Retinal Detachment Study.

Methods

During a 2-year period, we coordinated a comprehensive system in which every case of primary RRD presenting to 1 of 6 vitreoretinal surgical sites in Scotland was examined and approached for study inclusion.

Main Outcome Measures

Rhegmatogenous retinal detachment incidence, predisposing features, and clinical characteristics.

Results

A total of 1202 cases were recruited. Detailed clinical information was available on 1130 (94%) of cases. By causative break, the proportions of RRD were horseshoe tear (HST) associated with posterior vitreous detachment (PVD) in 86.2%, giant retinal tear (GRT) and PVD in 1.3%, non-PVD round hole (RH) in 4.9%, retinal dialysis in 5.9%, and retinoschisis RRD in 1.6%. One in 10 cases reported significant ocular trauma. One in 5 cases were pseudophakic. Round hole RRD more frequently presented with multiple retinal breaks compared with HST RRD (67.8% vs. 48.7%; P = 0.003). In PVD-associated RRD, 56.1% (95% confidence interval [CI], 53.8–58.3) of breaks were identified in the superotemporal retina. In non-PVD RRD, 54.6% (95% CI, 47.9–61.1) of breaks were inferotemporal, followed by superotemporal in 34.9% (95% CI, 28.7–41.5). Lattice degeneration was present in 18.7% of affected eyes and more common in RH RRD (35.7%) than in HST RRD (19.3%) (P = 0.003). Seven percent reported an affected first-degree relative, and these cases were significantly more myopic than nonfamilial cases.

Conclusions

More than 85% of RRD cases are associated with PVD and related tractional tears. Non-PVD RH RRD occurred in younger and more myopic individuals. The majority of cases are caused by more than 1 retinal break, and the macula is affected in more than 50% at presentation. Ocular trauma, previous cataract surgery, family history, and lattice degeneration are important predisposing features.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

The Scottish Retinal Detachment study was a prospectively recruited epidemiology study, the methodology of which has been described in detail.⁴ Between November 1, 2007, and October 31, 2009, we established a comprehensive system in which each primary RRD case presenting to 1 of the 6 vitreoretinal surgical centers in Scotland was approached for study inclusion. The study adhered to the tenets of the Declaration of Helsinki and was approved by the Multicenter Research and Ethics Committee

Results

A total of 1202 incident cases of primary RRD were recruited in Scotland over the 2-year study period. In 1130 cases, data were available on the clinical features of RRD. In total, PVD was present in 87.6% of cases (990/1130), with single or multiple HST RRD accounting for 98.5% of this group (975/990) and GRT RRD accounting for 1.5% of this group (15/990). Posterior vitreous detachment was absent in 12.4% of cases (140/1130), and these comprised RH RRD in 40% (56/140), retinal dialysis in

Discussion

This study represents some of the most extensive and detailed data ever compiled on the epidemiology of RRD and provides important clinical information for vitreoretinal surgeons and useful data for healthcare resource planning.

In our series, both PVD-present and PVD-absent RRD were more common in men. Rhegmatogenous retinal detachment associated with PVD demonstrated a higher proportion of right eyes affected and a peak incidence in the sixth decade of life. Rhegmatogenous retinal detachment

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Improved Outcomes with Heavy Silicone Oil in Complex Primary Retinal Detachment: A Large Multicenter Matched Cohort Study
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To establish whether Densiron 68, a heavier-than-water endotamponade agent, is an effective alternative to conventional light silicone oil in primary rhegmatogenous retinal detachment (RD) surgery for eyes with inferior breaks in the detached retina and severe proliferative vitreoretinopathy (PVR).
Cohort study of routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal database between 2015 and 2022.
All consecutive eyes that underwent primary rhegmatogenous RD surgery using Densiron 68 or light silicone oil as an internal tamponade agent.
To minimize confounding bias, we undertook 2:1 nearest-neighbor matching on inferior breaks, large inferior rhegmatogenous RDs, PVR, and, for visual analyses, baseline visual acuity (VA) between treatment groups. We fit regression models including prognostically relevant covariates, treatment–covariate interactions, and matching weights. We used g-computation with cluster-robust methods to estimate marginal effects. For nonlinear models, we calculated confidence intervals (CIs) using bias-corrected cluster bootstrapping with 9999 replications.
Presence of a fully attached retina and VA at least 2 months after oil removal.
Of 1061 eyes enrolled, 426 and 239 were included in our matched samples for anatomic and visual outcome analyses, respectively. The primary success rate was higher in the Densiron 68 group (113 of 142; 80%) compared with the light silicone oil group (180 of 284; 63%), with an adjusted odds ratio of 1.90 (95% CI, 1.63–2.23, P < 0.001). We also observed a significant improvement favoring Densiron 68 of –0.26 logarithm of the minimum angle of resolution (logMAR) in postoperative VA between the 2 groups (95% CI, –0.43 to –0.10, P = 0.002). The anatomic benefit of using Densiron 68 in eyes with inferior retinal breaks and large detachments was more pronounced among eyes with PVR grade C. We found no evidence of visual effect moderation by anatomic outcome or foveal attachment.
Densiron achieved higher anatomic success rates and improved visual outcomes compared with conventional light silicone oil in eyes with inferior retinal pathology and severe PVR.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
The genetics and disease mechanisms of rhegmatogenous retinal detachment
2023, Progress in Retinal and Eye Research
Rhegmatogenous retinal detachment (RRD) is a sight threatening condition that warrants immediate surgical intervention. To date, 29 genes have been associated with monogenic disorders involving RRD. In addition, RRD can occur as a multifactorial disease through a combined effect of multiple genetic variants and non-genetic risk factors. In this review, we provide a comprehensive overview of the spectrum of hereditary disorders involving RRD. We discuss genotype-phenotype correlations of these monogenic disorders, and describe genetic variants associated with RRD through multifactorial inheritance. Furthermore, we evaluate our current understanding of the molecular disease mechanisms of RRD-associated genetic variants on collagen proteins, proteoglycan versican, and the TGF-β pathway. Finally, we review the role of genetics in patient management and prevention of RRD. We provide recommendations for genetic testing and prophylaxis of at-risk patients, and hypothesize on novel therapeutic approaches beyond surgical intervention.
Retinal Detachment Associated with Retinal Dialysis: Clinical Features and Outcomes of Surgery in a 10-Year Study
2023, Ophthalmology Retina
To report the surgical approaches and outcomes in patients undergoing surgery for retinal detachment associated with retinal dialysis.
Retrospective, consecutive case series.
All patients who underwent surgery for retinal detachment secondary to retinal dialysis between January 1, 2012, and January 1, 2022.
Retrospective consecutive case series.
Best-corrected visual acuity (BCVA), single-operation success rate.
The study cohort included 60 eyes of 58 patients with a mean age of 26.4 (standard deviation, 13.0) years. Males comprised 49 (84.5%) patients. Known trauma occurred in 35 (61.4%) cases. Initial surgical management included scleral buckling (SB) in 49 (81.7%) eyes and combined SB and pars plana vitrectomy (PPV) in 11 (18.3%) eyes. Preoperative BCVA correlated with BCVA at last follow-up visit (r = 0.66; P < 0.001). At last visit, the SB group had a mean logarithm of the minimum angle of resolution BCVA of 0.36 (20/46) and a single-operation success rate of 76.9% at 6 months, whereas the SB/PPV group had a mean logarithm of the minimum angle of resolution BCVA of 1.08 (20/238) and single-operation success rate of 77.8% (P = 0.04 and P = 0.96, respectively). Six eyes in the SB/PPV group received silicone oil tamponade. In eyes with at least 1 year of follow-up, 4 (14.8%) in the SB group and 6 (100%) in the SB/PPV group developed a visually significant cataract requiring cataract surgery (P < 0.001).
Retinal detachment associated with retinal dialysis is typically associated with trauma and more often occurs in young male patients. The current study confirms that SB without PPV is an effective initial treatment strategy for most patients with retinal dialysis and has a low rate of cataract formation.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments: An International Multicenter Study
2022, Ophthalmology Retina
To determine the practice pattern for treating giant retinal tear (GRT) related detachments, and their anatomic and visual outcomes with pars plana vitrectomy (PPV) with or without scleral buckling (SB).
Retrospective cohort study.
Eyes with GRT detachments repaired from 2008 to 2020 with at least 6 months of follow-up from 7 institutions in North and South America, Europe, and Asia.
Eyes repaired using PPV versus PPV/SB were compared.
Anatomic and functional outcomes.
A comparable number of eyes underwent PPV (n = 101) and PPV/SB (n = 99). Except for history of developmental abnormalities, prior intraocular surgery, and lens status, no differences in baseline demographics, ocular characteristics, or intraoperative surgical adjuncts were observed. The overall single surgery anatomic success (SSAS) at 6 months and 1 year were similar between the groups (82.2% and 77.2% of PPV, and 87.9% and 85.7% of PPV/SB). When stratified by age, the 1-year SSAS rate was higher for PPV/SB (88.5%) than PPV (56.3%) (P = 0.03) for children <18 years. For both children and adults, the mean best-corrected visual acuity (BCVA) at baseline did not differ between the PPV and PPV/SB groups. However, for children, mean BCVA at 1 year was better in the PPV/SB than PPV groups (P = 0.001) while for adults, no difference was found between the 2 groups. The mean time to the first redetachment was 7.9 months in the PPV group and 5.5 months in the PPV/SB group (P = 0.8). Proliferative vitreoretinopathy was the most common cause for redetachment (70.4% of PPV and 93.8% of PPV/SB in redetached eyes; P = 0.1). Postoperative complications were also similar between the 2 groups, including ocular hypertension, epiretinal membrane, and cataract formation.
PPV and PPV/SB are equally popular among surgeons globally for managing GRT detachments and have comparable anatomic and visual outcomes in adults. In children, PPV/SB is superior to PPV for anatomic and functional success at 1 year. In adults, the relief of traction by the GRT may reduce peripheral traction and obviate the need for an SB. However, in children, a supplemental SB can be beneficial as complete vitreous shaving and posterior hyaloid detachment, and postoperative positioning, are difficult in this group.
Diagnosis and management of degenerative retinoschisis and related complications
2022, Survey of Ophthalmology
Citation Excerpt :
Byer reported that in his clinical practice asymptomatic schisis-detachments outnumbered the progressive, symptomatic variety by 178 to 118 and estimated PSSRD as a complication in only 0.05% of cases of degenerative RS. While a Scottish study found RS associated with 1.6% of primary rhegmatogenous RDs,63 Xue and coworkers calculated an annual incidence of PSSRD of only 0.85 per million in the United Kingdom (UK).96 On clinical exam, degenerative RS is characterized by a smooth, transparent elevation of the inner retinal layers that often has a pitted appearance.
Degenerative retinoschisis is a common condition characterized by elevation of the inner layers of the peripheral retina. While uncomplicated retinoschisis (i.e., with no associated retinal layer breaks) is almost invariably a benign process, retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) is fairly common. Historically, schisis-detachment has been treated with a variety of interventions, ranging from retinopexy to intraocular surgery. Based on published descriptions of the natural history of the disease, these interventions are likely unnecessary in many cases and may place the patient's vision at unnecessary risk. Progressive symptomatic schisis-related retinal detachment, on the other hand, is a vision threatening condition that requires intervention. While clinical examination remains the mainstay of diagnosis, recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring. When evaluating patients with peripheral retinal elevation, it is important for ophthalmologists to make an accurate diagnosis and to understand the risk-benefit ratio associated with intervention. Thus, we summarize the current literature on the natural history, clinical and imaging diagnosis, and surgical management of degenerative retinoschisis and its related complications.
Face-down positioning or posturing after pars plana vitrectomy for macula-involving rhegmatogenous retinal detachments
2024, Cochrane Database of Systematic Reviews

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: Manuscript no. 2010-929.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: This study was supported by a major Ophthalmology grant from the Royal College of Surgeons Edinburgh, the Royal Blind School Edinburgh/Scottish War Blinded, the W.H. Ross Foundation for the Prevention of Blindness and the Chief Scientist Office Scotland (CZB/4/705). The authors received (a proportion of their) financial support from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

: Competing interests: None declared.

: A list of members of the Scottish RD Study Group is available at http://aaojournal.org.

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Original articleThe Predisposing Pathology and Clinical Characteristics in the Scottish Retinal Detachment Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Materials and Methods

Results

Discussion

Ophthalmology

Surv Ophthalmol

Ophthalmology

Am J Ophthalmol

Risk factors for idiopathic rhegmatogenous retinal detachment

Am J Epidemiol

The epidemiology and socioeconomic associations of primary retinal detachment in Scotland: a two-year prospective population-based study

Invest Ophthalmol Vis Sci

Rhegmatogenous retinal detachment in Scotland: research design and methodology

BMC Ophthalmol

Ethnic differences in the demand incidence of retinal detachments in two districts in the West Midlands

Eye (Lond)

Epidemiological study of nontraumatic phakic rhegmatogenous retinal detachment

Ophthalmic Res

Retinal detachment in Chinese, Malay and Indian residents in Singapore: a comparative study on risk factors, clinical presentation and surgical outcomes

Int Ophthalmol

Northern New Zealand Rhegmatogenous Retinal Detachment Study: epidemiology and risk factors

Clin Experiment Ophthalmol

Demand incidence of retinal detachment in Brazil

Eye (Lond)

Original article
The Predisposing Pathology and Clinical Characteristics in the Scottish Retinal Detachment Study