Volume 36 Issue 7
Jul.  2023
Turn off MathJax
Article Contents

WANG Xin, ZHANG Ting, TANG Wen Yi, HUANG Xin. Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia[J]. Biomedical and Environmental Sciences, 2023, 36(7): 644-648. doi: 10.3967/bes2023.092
Citation: WANG Xin, ZHANG Ting, TANG Wen Yi, HUANG Xin. Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia[J]. Biomedical and Environmental Sciences, 2023, 36(7): 644-648. doi: 10.3967/bes2023.092

Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia

doi: 10.3967/bes2023.092
Funds:  This study was supported by the Health Science and Technology Project of the Pudong New District Commission of Health and Family Planning, Shanghai [grant no. PW2016D-12]; National Natural Science Foundation of China [grant no. 82070975]; Youth Project of the National Natural Science Fund [grant no. 81700861, 81500723, 82101150]; and Shanghai Sailing Program [21YF1405300].
More Information
  • Author Bio:

    WANG Xin, male, born in 1984, MD, PHD, Attending Doctor, majoring in Ophthalmology

    ZHANG Ting, female, born in 1981, MD, PHD, Associate Chief Physician, majoring in Ophthalmology

  • Corresponding author: HUANG Xin, Chief Physician, MD, PHD; Tel: 86-18917785526; E-mail: fd2017huangxin@163.com
  • WANG Xin, ZHANG Ting, and TANG Wen Yi participated in the collection of clinical information. WANG Xin and ZHANG Ting reviewed the literature and drafted the manuscript. HUANG Xin designed the study and critically revised the article. All authors have approved this version of the report for publication.
  • The authors have no conflicts of interest to declare.
  • &These authors contributed equally to this work.
  • Received Date: 2023-01-15
  • Accepted Date: 2023-05-18
  • WANG Xin, ZHANG Ting, and TANG Wen Yi participated in the collection of clinical information. WANG Xin and ZHANG Ting reviewed the literature and drafted the manuscript. HUANG Xin designed the study and critically revised the article. All authors have approved this version of the report for publication.
    The authors have no conflicts of interest to declare.
    &These authors contributed equally to this work.
  • 加载中
  • [1] Haarman AEG, Enthoven CA, Tideman JWL, et al. The complications of myopia: a review and meta-analysis. Invest Ophthalmol Vis Sci, 2020; 61, 49.
    [2] Beijing Rhegmatogenous Retinal Detachment Study Group. Incidence and epidemiological characteristics of rhegmatogenous retinal detachment in Beijing, China. Ophthalmology, 2003; 110, 2413−7. doi:  10.1016/S0161-6420(03)00867-4
    [3] Chen SN, Lian IB, Wei YJ. Epidemiology and clinical characteristics of rhegmatogenous retinal detachment in Taiwan. Br J Ophthalmol, 2016; 100, 1216−20. doi:  10.1136/bjophthalmol-2015-307481
    [4] Pan CW, Dirani M, Cheng CY, et al. The age-specific prevalence of myopia in Asia: a meta-analysis. Optom Vis Sci, 2015; 92, 258−66. doi:  10.1097/OPX.0000000000000516
    [5] Nuzzi R, Lavia C, Spinetta R. Paediatric retinal detachment: a review. Int J Ophthalmol, 2017; 10, 1592−603.
    [6] Takahashi H, Nakao N, Shinohara K, et al. Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT. Sci Rep, 2021; 11, 17330. doi:  10.1038/s41598-021-96783-w
    [7] Tsai ASH, Wong CW, Lim L, et al. Pediatric retinal detachment in an asian population with high prevalence of myopia: clinical characteristics, surgical outcomes, and prognostic factors. Retina, 2019; 39, 1751−60. doi:  10.1097/IAE.0000000000002238
    [8] Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology, 2007; 114, 2142−54. e4. doi:  10.1016/j.ophtha.2007.09.013
    [9] Issa R, Xia T, Zarbin MA, et al. Silicone oil removal: post-operative complications. Eye (Lond), 2020; 34, 537−43. doi:  10.1038/s41433-019-0551-7
    [10] Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vitrectomy and silicone oil injection. Ophthalmologica, 2018; 240, 129−34. doi:  10.1159/000489792
  • 23022+Supplementary Materials.pdf
  • 加载中
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Tables(7)

Article Metrics

Article views(325) PDF downloads(167) Cited by()

Proportional views
Related

Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia

doi: 10.3967/bes2023.092
Funds:  This study was supported by the Health Science and Technology Project of the Pudong New District Commission of Health and Family Planning, Shanghai [grant no. PW2016D-12]; National Natural Science Foundation of China [grant no. 82070975]; Youth Project of the National Natural Science Fund [grant no. 81700861, 81500723, 82101150]; and Shanghai Sailing Program [21YF1405300].
  • Author Bio:

  • Corresponding author: HUANG Xin, Chief Physician, MD, PHD; Tel: 86-18917785526; E-mail: fd2017huangxin@163.com
  • WANG Xin, ZHANG Ting, and TANG Wen Yi participated in the collection of clinical information. WANG Xin and ZHANG Ting reviewed the literature and drafted the manuscript. HUANG Xin designed the study and critically revised the article. All authors have approved this version of the report for publication.
  • The authors have no conflicts of interest to declare.
  • &These authors contributed equally to this work.
WANG Xin, ZHANG Ting, and TANG Wen Yi participated in the collection of clinical information. WANG Xin and ZHANG Ting reviewed the literature and drafted the manuscript. HUANG Xin designed the study and critically revised the article. All authors have approved this version of the report for publication.
The authors have no conflicts of interest to declare.
&These authors contributed equally to this work.
WANG Xin, ZHANG Ting, TANG Wen Yi, HUANG Xin. Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia[J]. Biomedical and Environmental Sciences, 2023, 36(7): 644-648. doi: 10.3967/bes2023.092
Citation: WANG Xin, ZHANG Ting, TANG Wen Yi, HUANG Xin. Clinical Manifestations and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment in Patients < 30 Years of Age with High Myopia[J]. Biomedical and Environmental Sciences, 2023, 36(7): 644-648. doi: 10.3967/bes2023.092
  • Primary rhegmatogenous retinal detachment (RRD) is a major cause of visual impairment. Extensive studies have shown that high myopia is a significant risk factor for RRD[1]. A bimodal age distribution of RRD has been reported in Chinese populations, with a major peak in the group of 60–69 years old and a smaller peak in the group of 20–29 years old[2]. A study in China has revealed a similar distribution and further indicated that the proportion and number of patients with RRD and high myopia peaked at the age range of 20–29 years[3]. Correspondingly, a high prevalence of myopia has been reported in Asians aged 20–29 years[4]. Thus, patients < 30 years with RRD and high myopia require special attention. However, limited studies have been conducted on RRD in young individuals with high myopia. Therefore, this study aimed to describe the clinical characteristics and surgical outcomes of patients < 30 years with RRD and high myopia. Furthermore, we focused on various factors that may correlate with surgical outcomes.

    This retrospective, single-center, observational study was performed at the Eye and ENT Hospital of Fudan University, Shanghai, China. The medical records for patients ≤ 30 years with high myopia [spherical equivalent (SE) ≤ –6 D or axial length ≥ 26.00 mm] who underwent primary RRD surgery performed by a single senior surgeon (X.H.) from June 2014–December 2018 were consecutively reviewed. This study adhered to the tenets of the Declaration of Helsinki and was approved by the Medical Ethical Committee of the Eye and ENT Hospital of Fudan University. Furthermore, written informed consent was obtained from each patient or their legal representative before the surgery. Patients with a minimum postoperative follow-up period of 6 months were included in this study. The exclusion criteria were retinal detachment (RD) caused by trauma, uveitis, traction, or other congenital abnormalities, such as familial exudative vitreoretinopathy, retinopathy of prematurity, Stickler syndrome, or Marfan syndrome. Patients with a history of ocular surgery for the affected eye within 1 year were also excluded.

    The patients underwent either scleral buckling (SB) or pars plana vitrectomy (PPV). The surgical approach was chosen based on clinical and anatomical features and determined at the discretion of the surgeon (X.H.). Generally, eyes with localized RRD associated with small anterior holes or retinal dialysis and without severe PVR are treated with SB. In contrast, the indications for vitrectomy include poor fundal view, severe PVR, and giant or posterior retinal breaks. During SB, patients underwent segmental buckling alone or in combination with encircling buckling using silicone tires. During PPV, patients underwent standard 23-gauge vitrectomy (Constellation; Alcon Laboratories, Fort Worth, TX, USA) using air, perfluoropropane (C3F8), or silicone oil (SO) endotamponade. Anatomical outcome measures included primary anatomical success (PAS), defined as a completely attached retina after the first surgery at the last follow-up, and final anatomical success (FAS), defined as a completely attached retina at the end of the follow-up period, regardless of the number of surgeries. PAS and FAS were considered only after the removal of the intraocular SO in cases involving SO endotamponade.

    Data collected from patient medical records included age, sex, axial length, refractive error, symptom duration, pre- and postoperative best-corrected visual acuity (BCVA), pre- and postoperative intraocular pressure (IOP), lens status, RD extent, RD maximum height (defined as the distance from the peak of RD to the wall of the eye, as measured using B-ultrasound), macular status (as determined by clinical examination or optical coherence tomography), retinal tear number, proliferative vitreoretinopathy (PVR) presence, endotamponade usage, and postoperative complications.

    Data were analyzed using statistical software (SPSS version 18; IBM Corporation, Armonk, NY, USA). The comparison of pre-operative and postoperative BCVA was performed using the Wilcoxon signed-rank test. Pearson’s chi-square test or Fisher’s exact test was used to compare the clinical characteristics between the two groups. The correlations between pre-operative and postoperative BCVA were analyzed using Spearman’s correlation coefficient. Multivariable logistic regression analysis was performed to identify the factors associated with surgical outcomes. A P-value < 0.05 was considered to be statistically significant.

    This study included 85 eyes of 76 patients aged < 30 years with high myopia. The characteristics of the study participants are summarized in Supplementary Table S1, available in www.besjournal.com. The high incidence of bilateral involvement (20.1% of 76 patients) was a notable feature of our patient cohort, with figures ranging from 0%–26% (mean, 9%) in previous reports[5]. This discrepancy may be related to the different inclusion criteria and the limitation to patients < 30 years with primary RRD and high myopia. Genetic susceptibility factors influence the development of high myopia at a young age, leading to abnormal characteristics of vitreoretinal development, such as the earlier occurrence of vitreous liquefaction and heightened risk of retinal degeneration.

    Demographics and characteristics Eyes of 76 Patients, n (%)
    Age, years22.25 ± 5.76 (range, 10–30; median, 22)
    Gender, n (%)
    Male42 (68.4)
    Female24 (31.6)
    Eyes, n (%)
    OD45 (52.9)
    OS40 (47.1)
    Mean axial length (mm)28.39 ± 2.17&
    Refractive error (SE)−8.76 ± 3.99#
    Surgical history, n (%)
    Posterior scleral reinforcement4 (4.7)
    Cataract extraction1 (1.2)
    Cataract extraction + IOL1 (1.2)
    LASIK3 (3.5)
    ICL2 (2.4)
    Mean follow-up time, months20.46 ± 11.35 (range, 8–53; median, 16)
      Note. N = 85; A total of 25 eyes of 16 patients with bilateral involvement were included. &Axial length data of 58 eyes were available. #Diopter data of 65 eyes were available. One eye had LASIK followed by ICL implantation 8 years later. ICL, implantable collamer lens; IOL, intraocular lens; LASIK, laser-assisted in-situ keratomileusis; RRD, rhegmatogenous retinal detachment; SE, spherical equivalen.

    Table S1.  Demographics of patients with RRD

    The clinical characteristics of patients with RRD and their respective features are shown in Table 1. In our study, round holes were the predominant type of retinal break; however, horseshoe and giant tears were observed in 22 (25.8%) and 6 (7.1%) eyes, respectively. Retinal tears often result from vitreoretinal traction during a posterior vitreous detachment (PVD), suggesting the occurrence of PVDs in this population. PVD has been detected using optical coherence tomography in young patients with high myopia[6].

    Characteristics No. of eyes (n = 85 eyes) SB
    (n = 54 eyes)
    PPV
    (n = 31 eyes)
    Symptom duration (days, mean ± SD) 40.11 ± 70.91
    (range, 2–360; median, 14)
    55.04 ± 85.41 14.10 ± 9.48
    Pathology, n (%)
    Single break 36 (42.4) 34 (63.0) 2 (6.5)
    Single round hole 32 (37.7)
    Single horseshoe tear 4 (4.7)
    Multiple breaks 43 (50.6) 20 (37.0) 23 (74.2)
    Multiple holes 25 (29.4)
    Multiple holes and tears 11 (12.9)
    Multiple horseshoe tears 7 (8.2)
    Giant retinal tear 6 (7.1) 0 (0) 6 (19.4)
    Total 85 (100) 54 (100) 31(100)
    Macula, n (%)
    On (fovea uninvolved) 22 (25.9) 19 (35.2) 3 (9.7)
    Off (fovea involved) 63 (74.1) 35 (64.8) 27 (87.1)
    PVR grade C or D 30 (35.3) 13 (24.1) 17 (54.8)
    RD extent, n (%)
    1 quadrant 28 (32.9) 23 (42.6) 5 (16.1)
    2 quadrants 32 (37.6) 26 (48.1) 6 (19.4)
    3 quadrants 15 (17.6) 4 (7.4) 11 (35.5)
    4 quadrants 10 (11.8) 1 (1.9) 9 (29.0)
    Total, n (%) 85 (100) 54 (100) 31 (100)
    Maximum height of RD (mm, mean ± SD) 3.37 ± 2.56 2.46 ± 1.11 5.07 ± 3.49
      Note. Data on the maximum height of RD in 83 eyes were available. PPV, pars plana vitrectomy; PVR, proliferative vitreoretinopathy; RD, retinal detachment; SB, scleral buckling.

    Table 1.  General clinical characteristics of patients with rhegmatogenous retinal detachment and the respective features of patients undergoing SB and vitrectomy

    Visual acuities before surgery and at the last visit are summarized in Table 2A. Our results showed that 41 (48.2%) and 79 (92.9%) eyes achieved 20/40 and 20/200 or better visual acuity, respectively, at the last follow-up, and the visual outcomes in our study were favorable compared to the findings of previous reports[7]. Furthermore, Tsai et al. have reported that 26 (50.0%) and 42 (82.6%) eyes with RRD in the pediatric population achieved a BCVA of 20/40 and 20/200 or better, respectively[7], and 24.3% of highly myopic eyes had a final BCVA of 20/200 or worse. According to the logistic regression analysis (Table 2B), a macula-off status and PVR grade of C or D were the two pre-operative factors significantly associated with poor visual outcomes in our study, similar to the findings of previous studies[5]. Fortunately, favorable anatomical outcomes can be achieved with surgery for primary RRD in young patients with high myopia. The PAS and FAS rates were 90.6% and 98.8%, respectively, similar to those reported previously[7].

    BCVA Mean Preoperative BCVA (n = 85) Mean Final
    BCVA (n = 85)
    P
    LogMAR VA 1.16 ± 0.78 0.47 ± 0.47 < 0.001
    Snellen VA
    ≥ 20/40 16 (18.8%) 41 (48.2%)
    20/200–20/40 29 (34.1%) 38 (44.7%)
    < 20/200 45 (47.1%) 6 (7.1%)
      Note. BCVA, best-corrected visual acuity; logMAR, logarithm of the minimal angle of resolution; VA, visual acuity.

    Table 2A.  Visual acuity before operation and at the last visit

    Risk factorOR95% CIP
    Macula-off status7.861.64–37.800.010
    PVR grade C or D3.511.04–11.900.044
    RD extent
    1 quadrant1.00
    2 quadrants1.230.32–4.480.765
    3 quadrants2.250.27–18.730.452
    4 quadrants0.420.47–3.680.432
    RD maximum height (mm)1.030.80–1.330.835
    PPV0.580.14–2.420.459
      Note. BCVA, best-corrected visual acuity; CI, confidence interval; OR, odds ratio; PPV, pars plana vitrectomy; PVR, proliferative vitreoretinopathy; RD, retinal detachment.

    Table 2B.  Multivariable logistic regression analysis of risk factors for a final postoperative BCVA worse than 20/40

    The surgeries performed are listed in Tables 34. Under favorable conditions, SB continues to be the first-line treatment for young patients with RRD. Most patients (63.5%) were treated with SB, which is consistent with the current treatment strategy for RRD[5,7]. This is because strong vitreoretinal adhesions in most young patients make vitrectomy challenging, and the risk of complications, such as cataract formation and elevated IOP, increases after PPV. These complications reduce the quality of life of young patients with long remaining lifespans. Nevertheless, SB, a classical and less invasive surgery than PPV, remains an effective treatment for RRD in select cases, especially in young patients[7]. Moreover, Heimann et al. have showed that greater BCVA improvement was achieved in phakic eyes in the SB group than in the PPV group[8]. However, vitrectomy has been suggested for complicated cases involving media haze, severe PVR, and multiple or posterior breaks. In this study, our patient underwent a second surgery because of PVR.

    RD surgery performed No. of eyes, n (%)
    Primary surgery
    SB 54 (63.5)
    Segmental 49 (57.6)
    Segmental + encircling 5 (5.9)
    PPV 31 (36.5)
    PPV + AIR 1 (1.2)
    PPV + C3F8 8 (9.4)
    PPV + SO 22 (25.9)
    Second surgery
    PPV + AIR 1 (1.2)
    PPV + C3F8 2 (2.4)
    PPV + SO 5 (5.9)
    Third surgery
    PPV + C3F8 1 (1.2)
      Note. N = 85; C3F8, perfluoropropane; PPV, pars plana vitrectomy; SB, scleral buckling; SO, silicone oil; RD, retinal detachment.

    Table 3.  RD surgery performed

    Twenty-four (28.2%) eyes had postoperative ocular hypertension; among them, 10 (11.8%) eyes had transiently raised IOP, 13 (15.3%) had medically controlled ocular hypertension, and 1 (1.2%) underwent Ahmed glaucoma valve implantation surgery because of medically uncontrolled ocular hypertension. The incidence of ocular hypertension in our study was higher than that in previous reports[7]. In Tsai’s study, 10 (6%) eyes had transient ocular hypertension, and 10 (6%) eyes had postoperative glaucoma[7]. In this study, multivariable logistic regression analysis (Supplementary Table S2, available in www.besjournal.com) showed that PPV was associated with greater odds of postoperative ocular hypertension (OR = 33.42; 95% CI, 2.15–520.52; P = 0.012). Two factors should be considered when interpreting this result: first, most of our PPV procedures were combined with SO tamponade, and previous studies have shown that ocular hypertension is a common postoperative complication of SO tamponade[9]; second, all patients included in our study were highly myopic, and high myopia is a risk factor for ocular hypertension after PPV[10]. In addition, 14 (16.50%) eyes had cataract formation, 13 cases of which occurred after PPV and cataract surgery was performed during follow-up.

    Risk factorOR95% CIP
    PPV*33.422.15−520.520.012
    Extent of RD0.396
    1 quadrant1
    2 quadrants3.160.19−52.660.423
    3 quadrants2.520.13−47.520.537
    4 quadrants0.150−9.220.365
    Maximum height of RD (mm)1.770.88−3.540.108
    Pathology0.997
    Single break1
    Multiple breaks1.030.11−9.910.982
    Giant retinal tear1.160.03−53.440.939
    Refractive error (SE)1.030.82−1.290.821
      Note. *Four patients who underwent SB followed by PPV were not included in the analysis. CI, confidence interval; OR, odds ratio; PPV, pars plana vitrectomy; PVR, proliferative vitreoretinopathy; RD, retinal detachment; SB, Sclera buckling.

    Table S2.  Multivariable logistic regression analysis of risk factors for postoperative ocular hypertension

    Our study had certain limitations. First, it was a retrospective study with a limited number of patients. Moreover, selection bias may have existed because this was a single-center study and a single surgeon performed all surgeries. Despite these limitations, this study enriches the understanding of the clinical characteristics and surgical outcomes of primary RRD in patients < 30 years with high myopia.

    The results revealed that good anatomical and functional outcomes can be achieved with surgery for primary RRD in patients < 30 years with high myopia. The macula-off status and PVR grade of C or D correlated with a greater likelihood of poor visual outcomes. PPV conferred a higher risk of postoperative ocular hypertension.

  • Additional surgeryNo. of eyes, n (%)
    SOR26* (30.6)
    Cataract surgery14 (16.5)
    LC + SOR3 (3.5)
    Phaco + SOR1 (1.2)
    Phaco + IOL + SOR3 (3.5)
    Phaco + IOL7 (8.2)
    Glaucoma filtering surgery1 (1.2)
      Note. N = 85; *The total number of eyes filled with silicone oil was 27. IOL, intraocular lens; LC, lensectomy; Phaco, phacoemulsification; SOR, silicone oil removal.

    Table 4.  Additional surgical procedures performed during the follow-up period after the primary surgery

Reference (10)
Supplements:
23022+Supplementary Materials.pdf

Catalog

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return