Functional Results

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Since the end of the 1960s, detachment surgery has been concentrating not only on anatomical results, but also on visual function [45-49] - both short-term recovery after surgery and long-term visual acuity.

In the first series, visual function was not described. In the remaining four series, treated with sponges or balloons, the mean visual acuity was 0.67 after 2 years (Table 6.4). The two questions that arise are: (1) Would visual acuity decline over years? (2) Would the presence of a segmental buckle over years cause a secondary deterioration of visual function?

These pending questions can be answered by the second series of 107 primary retinal detachments treated by minimal segmental sponge buckle(s) without drainage and with a complete follow-up of 15 years [40]. The mean preoperative visual acuity was 0.3; it improved to 0.5 during the first 6 months after surgery, and reached a maximum of 0.6 at 1 year. The increase was statistically significant (P<0.001). After 1 year, a slight linear decrease of 0.07 lines on the Snellen chart per year was observed over 15 years. In one patient, a cataract operation was done during the follow-up. The long-term functional results, including the surgical failures, are depicted in Fig. 6.15.

Table 6.4. Visual acuity at 2 years postoperatively after minimal segmental buckling (sponges or balloons) without drainage and reoperation of 1,462 primary detachments

Series

Detachment

Preoperative

Reoperation

Final

Visual acuity

proliferative

attachment

2 years postoperative

vitreoretino-

pathy C1-C2

First [21,39]

752

5

60

732

n.a.a

Second [26,40]

107

16

5

104

0.6

Third [41]

35

6

-

35

0.6

Fourth [42]

68

11

3

60

0.3

Fifth [37]b

500

5

39

493

0.7

Total

1,462

43 (2.9%)

107 (7.3%)

1,424 (97.4%)

0.67 (mean)

a Not available b Treated with balloon

Visual acuity

Fellow eye

0V21

Years postoperative o 1/21

11 15

Years postoperative

Fig. 6.15. Course of mean visual acuity of fellow and operated eyes during 15 years. Left: Course of mean visual acuity in the 107 unoperated fellow eyes during the 15-year follow-up. Right: Course of mean visual acuity in the 107 eyes with retinal detachment operated with extraocular minimal surgery (segmental sponge buckle(s) without drainage) during the 15 years after surgery. Preoperative visual acuity of 0.3 had increased to 0.5 at 6 months and to 0.6 at 1 year and decreased to 0.5 after 15 years. Of the patients, 72 were alive 15 years after the operation. During the study period of 15 years, the difference in decrease of visual acuity was not significant between the unoperated fellow eyes and the operated eyes (with the segmental buckle(s) in place) at any interval

To analyze whether this slight decrease in visual function could be due to the presence of the segmental buckle or to secondary complications, the visual acuity of the fellow eyes was compared with the operated eyes at all intervals. There was no significant difference (P=0.079) in visual acuity over the 15 years. In this context, the data of Slataper are of value [50]. He had plotted the visual acuity of 17,349 individuals as a function of age and found that after the age of 60, a linear decrease of 0.07 lines per year on the Snellen chart occurs and that this decrease is age-dependent. There is no statistically significant difference between the observed decrease over the years, determined by Slataper, and the one in the analyzed operated eyes.

Thus, postoperative visual acuity (even when including the surgical failures) with a maximum of 0.6 at 1 year after surgery had only slightly decreased to 0.5 during 15 years. There was no statistically significant difference from the course in the fellow eyes over the ensuing 15 years; it was due to aging.

Series 2 through 5, with a combined total of 710 retinal detachments treated with segmental sponges or balloons without drainage, provide useful data on postoperative visual acuity and its course over 2 years (Table 6.4) to 15 years (Fig. 6.15). The long-term postoperative visual acuity of the eyes treated with sewed-on buckles, limited to short segmental sponges to close the retinal breaks, confirm that minimal segmental buckling has no negative effect on long-term visual function.

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