Postoperative Retinal Detachment Follow-up

Updated: Feb 28, 2017
  • Author: Lihteh Wu, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Follow-up

Further Outpatient Care

According to the surgeon's discretion, an intraocular gas bubble may have been placed into the vitreous in the surgical repair of the RRD. If this is the case, the patient must adopt a certain head position for several weeks.

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Further Inpatient Care

Most vitreoretinal procedures are performed as ambulatory outpatient procedures.

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Inpatient & Outpatient Medications

Following vitreoretinal surgery, the patient is usually prescribed a topical prophylactic antibiotic, a topical corticosteroid (eg, prednisolone acetate), and a cycloplegic (eg, atropine 1%). The intraocular pressure is monitored during the postoperative period and treated as necessary with beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs.

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Deterrence/Prevention

It is good clinical practice that the general ophthalmologist dilates the pupil and examines the peripheral retina prior to cataract surgery and in the postoperative period after cataract surgery. If abnormalities are found, the patient should be referred to a vitreoretinal specialist for further management.

If a patient has risk factors for retinal detachment (eg, myopia, fellow eye retinal detachment, family history), a silicone IOL should not be placed. Instead, a foldable acrylic IOL is a better option.

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Complications

PVR is the most common cause of failure of surgical retinal reattachment surgery.

Elevated intraocular pressure is common after either vitrectomy with intraocular tamponade or scleral buckling procedures. Most cases respond to topical medications. Very seldom does one have to release the buckle or withdraw gas from the vitreous cavity.

Endophthalmitis following vitrectomy is rare. A scleral buckle may become infected and may need to be removed.

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Prognosis

Most series indicate that up to 95% of retinal detachment surgical cases are anatomical successes. Of these cases, as many as 50% obtain a visual acuity of 20/50 or better. [1, 14]

In a retrospective longitudinal cohort analysis of 9216 Medicare beneficiaries diagnosed with a rhegmatogenous retinal detachment between 1991-2007, patients who had undergone primary pneumatic retinopexy were 3 times more likely to receive a second retinal detachment operation compared to scleral buckling or pars plana vitrectomy. Risk of additional retinal detachment surgery did not differ significantly between scleral buckling and pars plana vitrectomy. Patients who had a pars plana vitrectomy were 2 times more likely to suffer adverse events as compared with those who had scleral buckling. [30]

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Patient Education

Patients should be educated regarding the symptoms of acute PVD, namely floaters and photopsia. Patients should be instructed to seek immediate attention if these symptoms occur.

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