I recently went through this article in eurotimes. We often say the size location pvr duration all are to be accounted for. But there is an interesting finding in this paper which suggests the different clock hours have different risks of redetachment and all quadrants should not recieve a standardized treatment but should be individualised. What are your experience on this? Have you noticed something similar among your patients?
I am planning a study to test this claim by looking at 5 years patients records undergoing retinal detachment surgeries. Anyone if willing to collaborate are highly welcome.
Causes of RRD surgery failure include:
1. Preoperative factors esp. the duration of RD , the extent of PVR and the presence of lower breaks (because the progression of RD is slow and the patient presents usually late with an old standing RD). The extent of RD does not affect the success of surgery in my experience) , large giant breaks increase the incidence of postoperative PVR.
2. Intraoperative factors esp the success of induction of PVD and the recognition of all breaks and their surrounding by laser and their proper tamponade. If this is not properly done , failure is more probable. Intraoperative haemorrhage increases the incidence of Both PVR and the incidence of rapid silicone oil emulsification
3. Postoperative factors include improper positioning to tamponade breaks and postoperative inflammation or haemorrhage increase the incidence of PVR
Very well said sir.
Do you have any thoughts or have you noticed anything similar to what the articles here claim regarding breaks with higher risk of redetachment being different at different Clock hours?
Lower breaks are usually associated with a slowly progressive RD and an upper visual field defect that is mostly noticed late by patients so they usually present with an old standing RD. Also gas and silicone oil tamponade upper breaks better than lower breaks with less limitation for the postoperative positioning which makes the success of surgery in upper breaks better. Breaks at 4 and 5 O'clock are mid way between upper and lower breaks with midway success rate in the effectiveness of their tamponade so recurrence incidence of RD is mid way between the other 2 groups.
The higher the break , the quicker is the spread of an upper detachment that causes a lower field defect easily recognized by the patient who will then present early with a better prognosis. Also the higher the break , the better is the tamponade and the better is the prognosis.
Very well understood sir. But arent both 11 and 1 at the same levels considering the height?the question is How is it that these two have completely different rate of redetachment?
11 and 1 O'clock should have similar rates of redetachment as I see in my practice.
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