|Year : 1988 | Volume
| 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
Raj Vardhan Azad
Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
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' the patient is aphakic. Associated myopia adds to the urgency. The higher incidence of initial right e' e involvement in all groups suggests a vascular original possibly ischaemic.
Keywords: Bilateral retinal detachment, unilateral retinal detachment, lattice degeneration, retinal tear, aphakic retinal detachment. Myopia.
|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;36:131-4
| Introduction|| |
"Every retinal tear has its detachment and every detachment has its tear" was the dictum enunciated by Gonin . 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 . 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 .
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<0.001). There were more males than females in all the groups. An overall test of the association between various groups and refractive errors was highly significant (X 2=56.59, P<0.001). [Table - 3] Although myopia was commonest refractive error encountered for all the types of retinal detachment, aphakic and aphakic myopic patients were greater in group-I patients. The distribution of retinal breaks in the three groups revealed uniform distribution with no statistically significant differences [Table - 4]. Highly Significant association was observed between the type of break and each retinal detachment group (X 2 =27.44, P<0.001). Arrowhead tears were responsible for retinal detachment in more than half of the cases in each group. In our series no patient had a macular hole and in 2% of group-I and group-III patients no hole was detected. Two or more tears in the detached eye were found significantly more often in group-I and group-Ill than in a group-II [Table - 5].
The temporal half particularly the superior temporal quadrant was the area where tears were situated most frequently in all groups [Table - 6]. Fellow eye changes in group-III patients showed a high preponderance of lattice degeneration. This was present in 74 percent of cases.
The frequency distribution of the presenting eye in each group showed greater right eye involvement [Table - 8]. Field loss was the commonest symptom noted by patients of all groups. [Table - 9]. More than 70 percent cases of retinal detachment in each group presented within 2 months of occurrence of their symptoms [Table - 10]. More than half of these patients sought ophthalmic care within 2 weeks. There was stastically no difference in the different types of retinal detachment in relation to the symptoms and their duration.
The occurrence of retinal detachment was 3.07±2.13 years in group-I, 3.73±4.45 years in group-TI and 6.45±4.60 years in group-III patients after the lens extraction. Myopic aphakics had lesser interval as compared' to their non-myopic counterparts. Half of the aphakic retinal detachments occurred within the first year of lens extraction.
| Discussion|| |
In different series the incidence of bilateral detachment has been reported as between 8 to 33%. , 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 ,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  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 . 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|| |
Gonin: Decollement de la retina: pathogenic-traitment, in Lausanne libraire. Lausanne, Switzerland, payot Et Cic, 1934.
Oku E: Gross microscopic pathology in autopsy eyes; III Retinal breaks without detachment. Am. J. Ophthalmol. 51:369-391, 1961.
Byer NE: Prognosis of asymptomatic retinal breaks. ARch. Ophthalmol 92:208-210, 1974.
Delaney WV, Oates RP: Retinal detachment in the second eye, Arch. Ophthalmol 96:629-634, 1978.
Duke Elder S: Text Book of Ophthalmology, London, Henry Kimpton, Vol.3, PP. 2864-2921, 1947.
Schepens CL, Marden D: Data on the natural history of retinal detachment. Arch. Ophthalmol. 66:631-642, 1961.
Benson WE, Grand, MG, Okun E: Aphakic retinal detachment Arch. Ophthalmol. 93:245-249, 1975.
Davis MD: Natural history of retinal breaks without detachment, Arch. Ophthalmol. 92:183-194, 1974.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10], [Table - 11]