A 21-Year Study Of Vitreoretinal Surgery For Aphakic Retinal Detachment: Long Term Surgical Outcomes And Complications

Purpose To determine the characteristics and outcomes of primary retinal detachment (RD) surgery in aphakic patients. Design Retrospective case series. Participants Sixty eyes with primary aphakic RD (ARD) in 51 patients. Methods A consecutive series of patients who underwent vitreoretinal surgery for primary rhegmatogenous ARD was analyzed retrospectively between 1997 and 2018 at Moorfields Eye Hospital. Main Outcome Measures Best-corrected visual acuity (BCVA), surgical outcomes, and complications. Results Mean BCVA improved from 1.31 to 1.08 logarithm of the minimum angle of resolution (logMAR; P  = 0.081) over a mean follow-up period of 8.2 years. Macula-off retinal detachments showed significantly improved BCVA from 1.72 to 1.1 logMAR ( P  = 0.007). Mean age was 38.8 years, and the most common cause of aphakia was congenital cataract surgery (55%). The macula was attached in 45% eyes, and grade C proliferative vitreoretinopathy (PVR) was present in 12%. Operations performed were vitrectomy (88%), combined vitrectomy and scleral buckle (8%), and encirclement (3%). The final anatomic success rate was 88%, and PVR was a significant predictor of redetachment ( P  = 0.03; odds ratio, 20.7; 95% confidence interval, 2.8–152.2). Raised intraocular pressure was the most common postoperative complication at 30%, with a rate of de novo postoperative glaucoma of 6.7% at final follow-up. Conclusions We report high rates of primary and overall anatomic success for surgery in ARD surgery. Grade C PVR was a positive predictor for surgical failure. Final visual outcomes were limited by ocular comorbidity, and we report significant improved visual outcomes for macula-off ARD.