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Selected Publication:
Augustin, P.
Anatomical and functional results after primary retinal detachment surgery at the Universitäts-Augenklinik Graz in 2001-2006
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp. 84
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- Authors Med Uni Graz:
- Advisor:
- Malle Eva Maria Birgit
- Wedrich Andreas
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- Abstract:
- Introduction: There is a controversy about superior treatment between scleral buckling and pars plana vitrectomy. In this study we compared outcome measurements of patients who had been treated for RRD in the period of 2001 to 2006 at the University Hospital Graz. Design: Retrospective data analysis Methods: In the first part of this diploma thesis, medical records of all patients, who underwent RRD treatment, either with scleral buckling procedures or 20-gauge pars plana vitrectomy between 01.01.2001 and 31.12.2005 at the University Eye Hospital Graz, were evaluated. It concerned patients who had been treated either by scleral buckling methods or by 20-gauge ppV. The results arising from this were described by descriptive statistics. Target values like age, macula status, lens status, differences in the duration of hospitalization, primary anatomic success rate as well as further re-detachment rate were analysed. In the second section the results of best-corrected visual acuity and intraocular pressure after scleral buckling methods versus 20-gauge ppV with gas tamponade were compared. Exclusion criteria were under-age, follow-up under 3 months, resurgery because of reamotio ,or other causes on the eye background and vitrectomy with a silicon-oil-tamponade. Normally distributed data were evaluated by parametic testing methods (student´s t-Test), data which were not normally distributed were evaluated by non-parametric testing methods (Mann-Whitney-U-Test, Wilcoxon Rank-Sum test). Results: Part I: In the period between 2001 and 2006, 472 patients underwent surgery because of retinal detachment. One patient was not included because of incomplete data. Scleral buckling methods were preferred (85%). 63 patients (13.4%) were re-operated. The highest primary reattachment rate resulted after scleral buckling treatment (80,5%), followed by vitrectomy with silicon-oil-tamponade (79,4%) and 20g ppV with gas tamponade (66,6%). No significant difference could be found between these methods (p=0,195). The redetachment rate amounted to 19.7% and was highest with vitrectomy with gas tamponade (33.3%). From the test results it cannot be assumed in general that there is a connection between the pre-operative lens status (p=0,235), the pre-operative macula status (p = 0,535) and the patient´s age at the time of the operation (p = 0,367) and the selection of the operation method. Part II: 128 patients were included for evaluation of the endpoints best- corrected visual acuity and intraocular pressure (see exclusion criteria in “Methods”). 117 (91%) were treated by scleral buckling methods and 11 (8.6%) by 20-gauge ppV with gas tamponade. The average hospitalization of 4.56 ± 1.37 days for the group of patients treated by the scleral buckling methods was significantly shorter (p=0.000) than in the group of 20-gauge ppV, where the hospitalization on average was 6.82±1.08 days. The intraocular pressure before and after surgery didn`t differ much when comparing the various surgical tecniques (p=0.559). As to the best-corrected visual acuity, the difference in the results of the two different surgical methods was more obvious (p=0,047). The best-corrected visual acuity of the patients undergoing the scleral buckling operation methods was significantly better (p=0,023) than that obtained by the 20g ppV with gas tamponade. Conclusion: In the period between 2001 and 2006 it was mainly the scleral buckling operation method that was applied. The baseline characteristics are consistent with the values shown in the literature. The hospitalization is much shorter with scleral buckling operations. In intraocular pressure there was no significant difference between the two methods. The best-corrected visual acuity was much better after the scleral buckling surgery. A possible explanation for this result could be the small number of patients in the group of vitrectomy and higher risk of cataract progression.