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Primary surgical management successful for round hole-related retinal detachment
Retinal detachments secondary to round holes were more common among patients who were young, myopic, female and had an inferior detachment, according to a study. Primary surgical management was usually successful and achieved good final visual acuity.
The retrospective review analyzed the incidence, characteristics, surgical management and outcome of 50 patients with a rhegmatogenous retinal detachment secondary to atrophic round retinal holes. All patients were treated by a single surgeon.
Median follow-up time was 0.65 years. Median age was 28.9 years, and 64% of study participants were female. The median spherical equivalent refractive error was –5.5 D.
The inferotemporal quadrant was the most common site for retinal holes, with 40% of patients exhibiting holes in this quadrant.
An external non-drainage procedure was performed in 92% of patients, with 88% receiving cryotherapy and 94% receiving an explant.
A successful surgical outcome was observed in all patients, with 94% achieving primary surgical success and 6% requiring further surgery. Snellen visual acuity of at least 6/12 was achieved by 78% of patients at final follow-up, with a median final visual acuity of 6/6.
“Patients diagnosed with a round hole-related retinal detachment in one eye must undergo careful examination of both eyes due to the high rate of round holes, potentially with an associated detachment present in the fellow eye,” the study authors said.
Perspective
Back to TopRound retinal holes are a less common but important cause of rhegmatogenous retinal detachments. It is one of the more common causes of retinal detachment in younger patients without a posterior vitreous detachment. Williams and colleagues detail their institution’s experience with this condition, confirming that young, myopic patients, many of whom have lattice degeneration, are at highest risk. This study reiterates a few points. First, younger patients who present with round retinal holes should be instructed to perform monocular vision testing and be seen immediately if they begin noticing a visual field deficit. While natural history studies suggest that the incidence of clinically significant retinal detachment is low in these situations, it certainly occurs and would not be unreasonable to consider prophylactic laser retinopexy in select cases as another option. Inferior quadrant holes concern me the most as these patients tend to present with very slow and chronically progressive detachments that are fairly asymptomatic until the fluid hits the macula. The study also demonstrates the excellent primary surgical success with scleral buckling in these younger patients and reinforces the need to continue to perform and teach scleral buckling techniques, especially in this subgroup of patients.