Clinical outcomes in sequential, bilateral rhegmatogenous retinal detachment: a multi-center, paired-eye analysis

PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by utilizing a paired-eye comparison. Design; Multi-center, retrospective cohort study SUBJECTS: Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV/SB over an 11-year period (October 2008 to April 2019) from four vitreoretinal practices were included. METHODS All subjects underwent repair of RRD and had a minimum of 6 months of follow up. Data was collected on patient demographics, duration of symptoms, anatomic characteristics of the RRD, surgical procedures, and best-corrected Snellen visual acuity (VA). These variables along with the single operation anatomic success (SOAS) and type and number of surgical procedures were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES SOAS between the initial and subsequent eye RRD. RESULTS 504 eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. SOAS in the initial eye was 82.5% with a mean of 1.2 surgeries (range 1-4). SOAS in the subsequent eye was 83.7% (p=0.80) with a mean of 1.2 surgeries (range 1-4, p=0.68). VA was better in the subsequent eye at presentation (mean 20/62 versus 20/149, p<0.001) and postoperative month 6 (mean 20/41 versus 20/49, p=0.03), but final VA was similar (20/36 versus 20/37, p=0.68). Macular detachment was less prevalent (34.1% versus 56.0%, p<0.001) with fewer quadrants detached (mean 1.9 versus 2.0, p=0.010) in the subsequent eye. Mean duration of symptoms before presentation was significantly shorter in the subsequent eye (mean 5.9 versus 7.5 days, p=0.008). In patients who underwent a different surgical technique in each eye, PPV/SB yielded a higher SOAS of 89.7% compared to 69.0% for PPV alone in 116 eyes (p=0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to present earlier and have less macular involvement, but the final VA outcomes were similar. PPV/SB yielded a significantly higher SOAS than PPV or SB alone.