[Late recurrences more than 1 year after primary successful surgery for rhegmatogenous retinal detachment].
BACKGROUND
Recurrent retinal detachment following initial successful surgery usually occurs in the early postoperative course. Redetachment after 1 or more years of complete retinal reattachment is a rare event. The present study investigates the frequency and causes of late recurrences.


METHODS
A consecutive series of 2,232 eyes that presented with rhegmatogenous retinal detachment (RD) were treated between January 1994 and December 2006. Among them were 30 cases (30 eyes) presenting with late recurrent RD (1.34 %). We compared the clinical characteristics of initial and late recurrent RD.


RESULTS
Over the 13-year period, 54.5 % of rhegmatogenous RD cases were treated with scleral buckling, 42.5 % using vitrectomy techniques and 2.55 % with pneumatic retinopexy. Late recurrent RD occurred 1.1 - 10.4 years (average 3.8, SD 2.56) after initially successful surgery. Previous surgery included scleral buckling in 24 eyes (80 %), vitrectomy in 5 eyes (16.7 %) and pneumatic retinopexy in another eye (3.3 %). At the time of initial treatment, primary reattachment rate was 93.3 % and final 100 %. At the time of late redetachment, the anatomic situation appeared more complex. Accordingly, most eyes were treated by vitrectomy (73.3 %), and only 23.3 % using buckling techniques. Furthermore, the numbers of reoperations to achieve reattachment increased from 6.6 % to 23.3 %. Major causes for late failures were vitreous base traction leading to new or reopened breaks and PVR. Three eyes showed these complications immediately after complicated anterior segment surgery. Comparing visual outcomes after initial (preop logMAR 0.57 +/- 0.7 and postop 0.38 +/- 0.43) and late (preop logMAR 0.87 +/- 0.71 and postop 0.66 +/- 0.5) RD, functional prognosis is worse when redetachment occurs. Nonetheless, in 50 % of eyes useful vision (>or= 20 / 50) was retained by repeat surgery.


CONCLUSIONS
Recurrent retinal detachment that presents after more than 1 year of complete reattachment occurs in 1.34 % of cases according to the present study. We found a higher rate after scleral buckling compared to vitrectomy. The most important reasons for late failures are vitreous base traction and periretinal proliferations that clinically appear as new or reopened tears or as PVR. Recurrences show a more difficult retinal situation and require more extensive surgical interventions. Based on the anatomic and functional success rates, repeat surgical procedures are worth considering.
Bopp
S
S
Augenklinik Universitätsallee, Bremen. s.bopp@retina.to
Böhm
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012163:Retinal Detachment / Q000175:diagnosis / Q000601:surgery*; D012591:Scleral Buckling; D014786:Vision Disorders / Q000175:diagnosis; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000175:diagnosis / Q000601:surgery