Clinical study of rhegmatogenous retinal detachment.

INTRODUCTION: Rhegmatogenous Retinal detachment is a condition that is associated with increased risk of visual morbidity.The various risk factors are Posterior capsular rent during cataract surgery,Myope,Trauma,YAG Capsulotomy,Family H/O RD,Fellow eye RD.The Major predisposing degeneration like Lattice degeneration,Snail track degeneration,focal pigment clumping are associated with increased incidence of RD.The Duration of Retinal Detachment and macula status upon presentation determines the functional successful visual outcomeTherefore a well organized systemic approach that is carried out with an awareness of early recognition of symptoms like floaters & flashes,reporting immediately can bring about good functional visual recovery.Hence a need for a study to know the risk factors of RD , to define the predisposing retinal degeneration in the fellow eye and its prophylactic treatment .and to analyze the Anatomical and functional visual outcome and cause of failure. MATERIALS AND METHODS: This Study included 30 new patients reporting to the Retina clinic ,RIOGOH,who were primarily managed with External Scleral buckling procedure using silicone explants.The Data of all patients will be collected on a proforma specially designed for this study and which includes detailed history,past surgical history,Anterior and Posterior segment examination,investigation and management by External sclera buckling using silicon explants.Prophylactic therapy given in other eye if needed in postoperative stay and follow up were analysed for correlation and recommendation. RESULTS: In our study the maximum incidence of Retinal Detachment was among 50-60 yrs age grp(33.33%).Males were predominately affected(76.67%). Right eye (60%) was more affected than left eye.12 pts(40%) presented within 1 month of Symptoms.14 cases (46.67%) had vision of less than <1/2/60.,while presenting preoperatively.Single break was seen in (56.67%).Horse shoe tear and irregular tear are common due to dynamic traction.Superotemporal quadrant is most common site of retinal break(48.57%).Total & Near total RD occurred in 17 cases(56.67).Macula was found detached in (80%) of cases upon presentation.Cryopexy with Encirclage & SRF drainage was done in most of the cases.93.33% attained anatomical reattachment.The cases which failed(6.67%) had risk factors like preoperative failure of localization of breaks & in another case redetachment following surgery due to new break.Most pt (46.67%) had good postoperative visual acuity of 6/60-6/24.4pts(57.14%) had lattice with small round hole.4pt(66.67%) are treated prophylatically with barrage laser,other pts with cryopexy and Encirclage.Detached Macula on initial examination and late reporting of retinal detachment account for the poor visual outcome. CONCLUSION AND RECOMMENDATION: In our study of 30 patients with Rhegmatogenous retinal detachment ,the maximum incidence was seen in the 50-60 yrs age group.Majority of the cases were Males and mostly had Right eye preponderance.Most patient presented within 1 month of onset of symptoms.Posterior capsular rent was major risk factor followed by Myopes in our study. Total (or) Near total rhegmatogenous retinal detachment predominated our study.Superotemporal quadrant had most number of breaks.Horse shoe tear was predominant break and majority presented with macular off status .Encirclage with cryopexy was the sheet anchor in the surgical intervention.Multiple lattice with pigmentary clumps with atropic round hole was major vitreoretinal degeneration in fellow eye.Barrage laser was the major prophylactic treatment,followed by cryopexy and encirclage. There was excellent anatomical attachment.The cause of failure was due to failure to seal the break and another due to redetachment with new Break. Our study highlights that Modern cataract surgery techniques and with modern instrumentation if meticulously used greatly prevents the occurrence of PC rent.All pseudophakes with known risk factors should be called for periodic review for detailed fundus examination. All myopes ,pseudophakes and aphakes should be educated on symptoms of flashes,floaters and to report immediately when symptomatic. This study also emphasis the prophylactic treatment of abnormal vitreoretinal degeneration and those presenting with break in superior quadrant within Lattice at the earliest to prevent occurrence of Retinal detachment, especially in Myopes. This study also emphasis importance of screening patients and with known risk factor and their proper recognition and early detection plays a valuable tool in the management of rhegmatogenous retinal detachment.