Risk of late redetachment / risk to fellow eye after primary RD

[kingofvarden]

Just wondering, Dr. Hagan, roughly how many patients you've had who have come to you with recurrent detachments after 1 or more years of complete attachment?

Online studies I'm seeing seem to give quite a wide range of percentages. Despite reading them in detail, I'm not always sure how they're carried out - do you just take note of all detachments you operate on during a particular period and say what percentage were late recurrences (possibly originally operated on by someone else), or do you follow up patients having operated on them for primary detachment and see how many get a late recurrence? Most of these studies seem to have only a 10-year running time and I'm imagining if the second method is used, the percentages they end up with may be rather on the low side for lifetime estimates.

Also the commonly quoted 15%-or-so risk to the fellow eye (is that lifetime risk? I'm also thinking probably a bit higher than this for aphakes like me) doesn't seem to take account of whether the fellow eye has already had a PVD. I did see one study on aphakes - admittedly a rather old one - that took account of PVD and found a ten-fold reduction in rate of detachment in the fellow eye if PVD was already complete - but no idea over what time period this ran. You can't follow people up indefinitely of course! (And ascertaining completeness of PVD can be tricky too).

Also, if the primary detachment was precipitated by PVD, would it not be likely that if the fellow eye was going to detach, it would usually (but not always) do so within a few years, since PVDs are quite often only a few years apart?

You will know all the studies (and many more) much better than I do, of course.

What I'm kind of getting round to saying is that I know RD patients are never out of the woods in either eye for the rest of their lives, but is the risk likely to be uniform throughout that time? Some of the studies seem to quote x% yearly risk, and I'm just wondering how useful that really is. I imagine it will also depend a fair bit too on cause of original detachment, as well as other predisposing factors. For late recurrences in the operated eye they seem to talk about contraction of residual vitreous around the vitreous base, which (as a non-medic) sounds to me like something that could randomly happen at any time to anyone, no matter how far from surgery it took place.

Not asking for odds in my particular case as my surgeon will be able to give more of an idea on that, but at the moment working with trying to come to terms with something like 20% lifetime risk to both eyes.

[kingofvarden]

Another question on this  occurred to me, and I'm just wondering, Dr. Hagan, if there is any data at all on this. I certainly can't find any and I suspect there may be no easy answer.

Do we happen to know which of the two eyes would be at greater future risk - an eye that has had successful reattachment surgery and has been stable for a year, or a fellow eye that has had "complete PVD" some years previously without any ensuing events?

I realise that technically there may be no such thing as "complete PVD" and there may always be adhesions around the vitreous base that could later cause tears, but for complete PVD I'm meaning all the areas of attachment that show up on OCT scans are detached (fovea, optic disc, etc.). As discussed, I'm still not sure even if I have this kind of "complete PVD", but will probably try to find out next time I get an OCT scan. It does sound as if less emphasis is placed on vitreous status these days when deciding how risky things are for the fellow eye, although this lack of emphasis may just be the way some of the recent studies (eg. the big Danish one) were carried out.

Slowly working on my anxiety around all this and making some progress I think. Part of the fear comes from the fact that detachment is comparatively rare, and being an aphakic patient makes me a (somewhat) rare patient even within this cohort. It does sound, though, as if things would still be treatable were anything further to happen.

[JohnHaganMD]

If the retina has been successfully re-attached and stayed in place for 6-12 months, as a generalization the fellow eye is at higher risk. This assumes no oil has to be put in the eye.

[kingofvarden]

OK thanks for that, Dr. Hagan - that's helpful to know.

[JohnHaganMD]

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[JohnHaganMD]

Retinal detachments (RD) are notoriously unique and difficult to generalize about.  I don't do RD surgery but the incidence of RD has declined dramatically over the last 30 years for a variety of reasons. The highest risk of RD occurs during a PVD process which can last days to months.  Over time the risk diminishes.  Of patients of mine that I've referred to our RD surgeons those attached at 4-6 months rarely ever re-detach.  The highest risk of recurrent RD occurs in special types of RD called 'traction RD or Giant RD or with extensive preretinal fibrosis"     I can't give you "odds" but I believe its quite a bit less than 20% as a generalization. Discuss with your eye MD ophthalmologist who can handicap the odds better.

[kingofvarden]

Thanks Dr. Hagan - that's very helpful indeed (and reassuring too). I'll make a detailed list of questions for my retinal consultant in time for my next appointment with her.

[JohnHaganMD]

Best of luck

[kingofvarden]

Thanks Dr. Hagan. Just as a brief follow-up to this, I thought I'd just post here links for abstracts of two studies which seem to be at the extremes of the spectrum for late detachments. Both are on scleral buckling so not directly relevant to me, but I imagine there must be as much variation within vitrectomy too:

https://www.ncbi.nlm.nih.gov/pubmed/17114991

and

https://www.ncbi.nlm.nih.gov/pubmed/19432848

It seems a stark difference - one says 0.39% for late recurrences and the other says 5%, roughly within the same time-frame - that's more than a tenfold difference. Surely there can't be that wide a difference, even allowing for differences in skill of the surgeon? But I can't find anything else explaining these kinds of discrepancies - one would have thought that even differences in methodology shouldn't lead to that wide of a gap between the two. There seems to be less long-term data on vitrectomies but what little I've seen looks reasonably encouraging, although certainly not totally immune from this problem of late redetachments.

Still planning to discuss my own particular odds with my surgeon when I see her.

[MrPresley]

My only residual effect remaining after a vitrectomy I had performed for macular traction almost two years ago now is minor macular edema.  The other non-operative eye also has been diagnosed with macular traction, but no visual effects thus far have occurred as a result.  No scleral buckle was used in my case.

[kingofvarden]

I didn't have a buckle either. With me, the optometrist also picked up very mild macular oedema on OCT but nothing worrying so far and nothing that either of my two consultant ophthalmologists are concerned about.

[kingofvarden]

I'm 41 so the difference between these two studies would be like light and day to me. First one = 0.39% over 15 years - multiply by 3 and you get lifetime risk of 1.17%. Second one = 5% over 10 years - multiply by 4 and you get lifetime risk (possibly rather low estimate) of 20%. Still way more likely not to happen than to happen, of course. As I said before, neither directly apply to me anyway because they're scleral buckling but certainly gives some idea of the variation there seems to be!

[kingofvarden]

*night and day, rather than light and day

[JohnHaganMD]

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