Indian Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 1988  |  Volume : 36  |  Issue : 3  |  Page : 131--134

Risk factor profile in retinal detachment


Raj Vardhan Azad, BK Nayak, YR Sharma, Hem K Tiwari, PK Khosla 
 Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi - 110 029, India

Correspondence Address:
Raj Vardhan Azad
Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi - 110 029
India

Abstract

150 cases of retinal detachment comprising 50 patients each of bilateral retinal detachment, unilateral retinal detachment without any retinal lesions in the fellow eve and unilateral retinal detachment with retinal lesions in the fellow eye were studied and the various associated risk factors were statistically analysed. The findings are discussed in relation to their aetiological and prognostic significance in the different types of retinal detachment. Based on these observations certain guidelines are offered which may be of value in decision making, in prophylactic detachment surgery. Tractional breaks in the superior temporal quadrant especially when symptomatic. mandate prophylactic treatment. Urgency is enhanced it«SQ» the patient is aphakic. Associated myopia adds to the urgency. The higher incidence of initial right e«SQ» e involvement in all groups suggests a vascular original possibly ischaemic.



How to cite this article:
Azad RV, Nayak B K, Sharma Y R, Tiwari HK, Khosla P K. Risk factor profile in retinal detachment.Indian J Ophthalmol 1988;36:131-134


How to cite this URL:
Azad RV, Nayak B K, Sharma Y R, Tiwari HK, Khosla P K. Risk factor profile in retinal detachment. Indian J Ophthalmol [serial online] 1988 [cited 2020 Apr 9 ];36:131-134
Available from: http://www.ijo.in/text.asp?1988/36/3/131/26129


Full Text

 Introduction



"Every retinal tear has its detachment and every detachment has its tear" was the dictum enunciated by Gonin [1]. To find a tear and seal it, remains the corner-stone of present day detachment surgery, but how dangerous a retinal tear alone is, does need some rethinking. Histo-pathological studies in­dicate that between 5 to 8 percent of autopsy eyes have retinal breaks with no retinal detachment [2]. This has received clinical support from the rarity of progression of such lesions to manifest detach­ment in a long term follow-up study of asymptomatic retinal breaks [3].

Therefore the course and final outcome of any detectable retinal tear or lesion depends not on its presence alone. Various associated factors play a role in determining whether a retinal detachment will or will not result.

It was therefore thought worthwhile to study the differences between bilateral and unilateral detach­ments with and without retinal lesions in the fellow eye. The differences, it was felt, would be of help in identifying the various possible risk factors which are associated with the development of retinal detachment especially in the fellow eye.

Better information on these lines would be of obvious help in determining factors which militate the need of prophylactic interference in the fellow eye.

 Material and Methods



453 cases records of consecutive retinal detachment patients operated at Dr. R.P. Centre for Ophthalmic Sciences were analysed. Of these fifty had bilateral detachment (group- I). Data obtained from these fifty patients was compared to a group of first fifty presenting eyes i.e. with unilateral retinal detachment without any detectable retinal lesion in the other eye (group-II) and unilateral retinal de­tachment with retinal lesions in the fellow eye (group-III). The lesions studied in the fellow eye included retinal breaks, lattice like degeneration, snail track degeneration, vitreous traction, paving stone degeneration, white without pressure, myopic chorioretinal degeneration and retionoschisis.

A complete medical and ophthalmic history with special reference to retinal detachment, lens extrac­tion in aphakic patients and refractive error was obtained. Examination included binocular indirect ophthalmoscopy with scleral depression and, when indicated, Goldman three mirror contact lens examination. Patients were followed up for at least six months. The various risk factors in relation to retinal detachment were noted and statistically analysed.

 Results



Incidence of bilateral retinal detachment in our series of 453 patients was 11.03%. The mean interval between the involvement of the fellow eye was 2.60±2.59 years (M±SD). But in nearly 30% of patients the second eye was affected within a year of detachment in the other eye. In 14% of patients the second eye was affected after more than 5 years. Age distribution indicated peak inci­dence in all groups between 41 and 60 years. The patients with bilateral detachments (group-I) had the highest mean age and patients with unilateral detachment with no lesions in the contralateral eye had the lowest mean age indicating a stepwise increase in mean age in accordance with the extent and degree of involvement of the two eyes. [Table 1] The sex distribution with mean age in the three groups [Table 2] indicated a highly significant association between sex and type of detachment observed (X 2=25.18, P 2=56.59, P 2 =27.44, P [5],[6] The low incidence of 11.03 percent bilateral detach­ments in 453 consecutive cases in our study reflects the prevalence at the initial presentation. Patients reported herein have been followed up for 6 months and not for the recommended 10 years [8],9. In bilateral cases the mean interval between detachment in two eyes was 2.6 years and in 14% of patients the second eye -was affected after more than five years. This stresses the need for careful follow-up of the fellow eye on a long term basis. Delaney and Oates noted second eye involvement up to 30 years after the first eye had retinal detachment. a The need for careful fellow eye follow-up is also stressed by the fact that it has been reported that in 57 percent of patients the fellow eye had a detachment. In all our groups males showed a higher incidence and the mean age in the three groups showed stepwise increase. This indicates expected progression of unilateral detachment with retinal lesions in the contralateral eye to ultimate bilateral detachment. This again favours long term careful follow up of the second eye.

Aphakia and aphakic myopes showed a significantly higher prevalence in group-I as compared to group-II and group-III patients. The risk of retinal detachment in the second eye has also been reported to be greater in aphakic detachment patients [7] The fact that more than 50% of cases of aphakic detachments occurred after the first year of liens extraction emphasises the fact that high risk detach­ment patients cannot be declared safe even if one year has elapsed since the lens extraction. It is emphasised that aphakic myopes have greater vul­nerablity to retinal detachment than simple aphakis.

Tractional breaks were present in 76 percent in group-I, 72 percent in group-II and 66 percent in group-Ill patients. Hence any such break should be carefully treated even if it has not caused clinical detachment of the retina at the time of examination. Majority of Group - II patients had single tears when majority of Group - I&III patients had multiple tears. This indicates that multiple, tears are seen in the more advanced stage_ of retinal pathology and are probably more dangerous and thus require prophylactic treatment.

Maximum frequency of the tears in the superior temporal quadrant in the three groups indicates that this area needs most careful evaluation in retinal detachment patients . The high incidence of lattice like degeneration in the fellow eyes of group-III and also the first eye affected in group-I was more often in the right eye. This suggest the ocular blood supply and branching of the carotids may be of some significance.

Greater severity of bilateral detachment has been indicated because of more reoperations and fewer successes [4]. Our data does not support this. There seems to be greater involvement of second eye with increasing age especially in males but surgical prognosis is not affected. Our data indicates that all unilateral retinal detachment patients who have tractional breaks especially in the superior temporal quadrant and more so when these are symptomatic should be immediately treated prophylactically. This would be of even greater urgency if the patient is aphakic; associated myopia adds to the urgency.

References

1Gonin: Decollement de la retina: pathogenic-traitment, in Lausanne libraire. Lausanne, Switzerland, payot Et Cic, 1934.
2Oku E: Gross microscopic pathology in autopsy eyes; III Retinal breaks without detachment. Am. J. Ophthalmol. 51:369-391, 1961.
3Byer NE: Prognosis of asymptomatic retinal breaks. ARch. Ophthal­mol 92:208-210, 1974.
4Delaney WV, Oates RP: Retinal detachment in the second eye, Arch. Ophthalmol 96:629-634, 1978.
5Duke Elder S: Text Book of Ophthalmology, London, Henry Kimpton, Vol.3, PP. 2864-2921, 1947.
6Schepens CL, Marden D: Data on the natural history of retinal detachment. Arch. Ophthalmol. 66:631-642, 1961.
7Benson WE, Grand, MG, Okun E: Aphakic retinal detachment Arch. Ophthalmol. 93:245-249, 1975.
8Davis MD: Natural history of retinal breaks without detachment, Arch. Ophthalmol. 92:183-194, 1974.