Rhegmatogenous Retinal Detachment (RRD) Follow-up

Updated: Oct 08, 2019
  • Author: Lihteh Wu, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Follow-up

Further Outpatient Care

Depending on the presence or absence of an intraocular gas bubble, the patient will be instructed to maintain a certain head position.

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Further Inpatient Care

Currently, most vitreoretinal surgery is performed as an outpatient procedure.

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Inpatient & Outpatient Medications

Following surgery, most surgeons elect to place the patient on a topical antibiotic for prophylaxis for 7-10 days, a cycloplegic agent (eg, atropine 1%) for about 1 month, and a topical steroid (eg, prednisolone acetate 1%) also for about 1 month. The intraocular pressure is monitored during the postoperative period and treated as necessary.

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Deterrence/Prevention

The principal cause of a rhegmatogenous retinal detachment (RRD) is the formation of a retinal break following a PVD.

To prevent a RRD from occurring, one could try to find a way to prevent vitreous syneresis or PVD. So far, no such prevention method is available.

Another strategy would be to relieve vitreoretinal traction. Currently, the only known way to do this is through surgery (i.e., scleral buckle, vitrectomy). However, the risks of these procedures do not justify their use in the prevention of a RRD.

The third strategy is to create chorioretinal adhesions around pre-existing retinal breaks and other visible predisposing lesions. One must consider whether other risk factors are present (eg, myopia, fellow eye RRD, family history, previous cataract surgery) and whether the patient is symptomatic. On one hand, asymptomatic patients with visible lesions (eg, lattice) probably have a very low risk of retinal detachment. These patients can be observed without treatment. On the other hand, myopic, pseudophakic patients with a RRD in the fellow eye with visible lesions should be strongly considered for prophylactic treatment.

Whether laser treatment is in fact beneficial in preventing a RRD in fellow eyes is not known. However, the adverse effects are minimal and the potential benefits are great. One must caution the patient that despite prophylactic treatment, a retinal tear may still occur. On the other hand, Wilkinson concluded that no conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or asymptomatic lattice degeneration. [45]

Individuals with a RRD have a higher risk of developing a RRD in the fellow eye if it is pseudophakic or has a more myopic refraction. [46]

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Complications

See the list below:

  • PVR is the most common reason for surgical failure.

  • Rubeosis iridis

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Prognosis

Retinal reattachment surgery has improved over the past few decades. Currently, as many as 95% of patients can have an anatomical success. Visual prognosis depends on whether the macula is attached at the time of surgery. Once the macula is detached, the photoreceptors start to degenerate, impairing the visual recovery. Several factors affect the visual prognosis of a macula-off detachment. The most important factor affecting postoperative visual acuity is the preoperative visual acuity. [47]

Persistent subfoveal fluid and increased preoperative foveal thickness are associated with a worse visual prognosis in macula-off RRD. [48] One report states that a macula off detachment can be operated within the first 3 days after presentation without compromising the patient's visual prognosis. [49] It is believed that only 50% of patients with a macula-off detachment attain a visual acuity of 20/50 or better. The height of the macula appears to also play a role in the postoperative visual acuity. Shallow macular detachments were associated with a better visual outcome. [50]

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 to those who had scleral buckling. [51]

Spectral-domain optical coherence tomography may be used to predict the visual outcome after successful RRD repair. The status of the external limiting membrane, ellipsoid, and the outer nuclear layer are important determinants of postoperative visual acuity. [52]

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Patient Education

Warn patients who experience a retinal detachment of the potential risk to the fellow eye. In phakic eyes, the risk is estimated to be 10-15%. In aphakic or pseudophakic eyes, the risk increases to 25-40%.

Instruct patients to seek attention immediately if they start experiencing floaters and/or photopsias.

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