Influence of drainage retinotomy on anatomical and visual outcomes of pars plana vitrectomy for primary rhegmatogenous retinal detachment.

OBJECTIVES

To assess the influence of drainage retinotomy (DrR) on anatomical and visual outcomes of pars plana vitrectomy (PPV) for primary uncomplicated rhegmatogenous retinal detachment (RD), compared with drainage through pre-existing retinal break (PRB).

METHODS AND ANALYSIS: Retrospective study on patients treated with PPV for RD. Prospectively collected data were extracted from the Britain & Eire Association of Vitreoretinal Surgeons and European Society of Retina Specialists (EURETINA) RD database, including baseline features, surgical details, and anatomical and functional outcomes. Inclusion criteria were as follows: uncomplicated PPV, gas tamponade, drainage through DrR or PRB, surgeons with >100 cases recorded. Exclusion criteria were as follows: age <16, <2-month follow-up, ocular comorbidity, proliferative vitreoretinopathy ≥grade C, giant retinal tear, tamponade other than gas. Full propensity score matching resulted in matched groups to mitigate confounding bias. Subsequent multivariable linear regression was performed for postoperative best-corrected visual acuity (BCVA) as dependent variable, and Firth penalised logistic regression with DrR, single-surgery anatomical success (SSAS), epiretinal membrane (ERM) and macular fold as dependent dichotomised variables on matched data.

RESULTS

Of 12 504 eyes extracted, 4175 were included. Of these, 3432 (82.2%) had PRB drainage (non-DrR group) and 743 (17.8%) a DrR (DrR group). Final median (IQR) BCVA was 0.18 (0.14-0.48) in the non-DrR group and 0.20 (0.18-0.48) in the DrR group (p=0.072). SSAS rate was 93.4% and 91% (OR 0.71 (95% CI 0.54 to 0.95)) and postoperative ERM rate 1.6% and 4.2% (OR 2.63 (95% CI 1.68 to 4.10)) in the non-DrR and DrR groups, respectively. On multivariable regression, DrR was associated with postoperative ERM (p=0.011), but not with final BCVA, SSAS and macular folds (p=0.633, 0.149 and 0.085, respectively).

CONCLUSION

Our study confirmed the association between DrR and increased risk of developing ERM; however, DrR does not appear to impact significantly on other outcomes.