Analysis of risk factors for the outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes

Background: To compare the preoperative risk profiles of phakic and pseudophakic eyes with primary retinal detachment and to assess their impact on the outcome of primary reattachment surgery. Patients and methods: 220 consecutive patients with primary retinal detachment, 165 phakic and 55 pseudophakic eyes were operated with scleral buckling alone or additional vitrectomy and followed up for 6 months. Pre-, intra- and postoperative risk factors were recorded and their impact on anatomical outcome after primary surgery in phakic and pseudophakic eyes was then compared in a multivariate regression analysis. Results: The cumulative probability of anatomical success 6 months after surgery was similar in phakic (88.5%) and pseudophakic eyes (86.3%; log rank = 0.340). The most important risk factor for a different surgical outcome between phakic and pseudophakic eyes was the size of retinal detachment (p = 0.035). In, phakic eyes the size of retinal detachment had no significant impact on surgical outcome (1 vs. 4 quadrants; log rank = 0.135); whereas in pseudophakic eyes a significant impairment on surgical outcome was found (1 vs. 4 quadrants; log rank < 0.001). The relative risk for failure of primary surgery due to retinal detachment of at least 3 quadrants was in phakic eyes 1.22 (CI: 0.71 - 1.70), in pseudophakic ones 1.81 (CI: 0.88 - 2.59). Conclusions: The outcome of primary retinal reattachment surgery in phakic and pseudophakic eyes is similar for retinal detachments up to 3 quadrants. In retinal detachments of more than 9 clock times, the size of retinal detachment impairs the surgical outcome in pseudophakic eyes more than in phakic ones. The combination of extraocular surgery with vitrectomy in pseudophakic eyes with retinal detachment of more than 9 clock times contributes to a better outcome.