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Acta Ophthalmologica 2012
Outcome of surgery after macula-off retinal detachment – results from MUSTARD, one of the largest databases on buckling surgery in Europe Results from a large German case series Ulrich Thelen,1 Susanne Amler,2 Nani Osada2 and Heinrich Gerding3 1
Germany Eye Hospital University of Mu¨nster, Mu¨nster, Germany Department of Medical Informatics and Biomathematics, University of Mu¨nster, Mu¨nster, Germany 3 Eye Center Pallas Clinic, Olten, Switzerland 2
ABSTRACT. Purpose: To evaluate the anatomical success rate of scleral buckling surgery in the treatment of rhegmatogenous retinal detachment and to evaluate the differences in outcome between patients suffering macula-off retinal detachment and those without a macular involvement. Methods: As a retrospective interventional case series, Munster Study on Therapy Achievements in Retinal Detachment (MUSTARD) is one of the largest ever established of retinal detachment patients and their outcome after buckling surgery, with 4325 patients who underwent surgery between 1980 and 2001. In 53.94% (n = 2134) of 3956 patients with nontraumatic retinal detachment, the macula was involved. The main outcome measure was the achievement of dry anatomical attachment of the retina. Results: The success rate in patients with macula-off retinal detachment is 80.46% and thus 7.78% lower (p < 0.01) than that in those patients with their macula intact whose success rate amounted to 88.24%. The overall success rate of all 4325 MUSTARD patients was 83.98%. Conclusions: Scleral buckling is an established and mostly successful method for the treatment of retinal detachment. As our case series has demonstrated, even eyes with macula-off can be treated successfully by this procedure, thereby avoiding the complications of primary vitrectomy. Key words: macula-off – retinal detachment – retinopexy – scleral buckling – vitrectomy
Acta Ophthalmol. 2012: 90: 481–486 ª 2010 The Authors Journal compilation ª 2010 Acta Ophthalmol
doi: 10.1111/j.1755-3768.2010.01939.x
Introduction Rhegmatogenous retinal detachment is a major sight-threatening disease of
the posterior segment of the eye that can be cured by surgery alone. Risk factors for retinal detachment include, among others, age, aphakia, myopia,
pseudophakia, recent eye surgery and trauma. With current surgical techniques, 90% or more of all retinal detachments can be successfully reattached with one or more operations (Wilkinson 2006), (Ho et al. 2002), (Afrashi et al. 2005). The two current – and, in some surgeons’ opinion, competing – methods of treatment are scleral buckling with the intent to facilitate a reattachment and primary pars plana vitrectomy (PPV). In some surgical centres, a combination of the two procedures might be employed. The anatomical success rate is dependent on preoperative pathology; anatomical success rates after buckling surgery or PPV may be as high as 96% (La Heij et al. 2000). One aspect of preoperative pathology that has a major impact on the anatomical and functional outcome of surgery is whether the macula is still attached or is part of the detachment (Doyle et al. 2007), (Oshima et al. 2000). After a macula-off retinal detachment, improvement of central vision often remains compromised owing to the permanent functional damage the macula has suffered while detached. Even in cases where surgery has been successful, a reattached retina with macula-off rarely regains normal sensitivity or acuity (Diederen
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Acta Ophthalmologica 2012
et al. 2007). Several studies have concluded that the outcome of the surgical repair of macula-off retinal detachment is time dependent. Better visual acuity was achieved in a group that was treated
