Bilateral Sequential and Simultaneous Rhegmatogenous Retinal Detachments : Analysis of the Anatomical and Functional Outcomes

Authors: Sihame Doukkali, Mélanie Hébert, Eunice You, Mohammadhossein Ghasempourabadi, Serge Bourgault, Mathieu Caissie, Éric Tourville, Ali Dirani. 

Author Disclosure Block: S. Doukkali: None. M. Hébert: None. E. You: None. M. Ghasempourabadi: None. S. Bourgault: None. M. Caissie: None. É. Tourville: None. A. Dirani: None.

Purpose: To assess the anatomical and functional outcomes in sequential or simultaneous bilateral rhegmatogenous retinal detachment (BRRD). Study Design: Retrospective cohort study 

Methods: Medical records of patients undergoing surgery for sequential or simultaneous BRRD between 2014 and 2020 at the Centre hospitalier universitaire de Québec - Université Laval were retrospectively reviewed. During this period, 218 eyes of 109 patients were included. Data were collected on patient demographics, preoperative characteristics, intraoperative management, single surgery anatomic success (SSAS), complications, and final pinhole visual acuity (PHVA) in logarithm of the minimal angle of resolution (logMAR). 

Results: Of the 109 patients included, 79% were men and 21% were women. There were 92% (n=101) of patients with sequential BRRD and 8% with simultaneous BRRD. Median [Q1, Q3] age at presentation for the first eye was similar between both groups (simultaneous: 60 [38, 64] vs. sequential: 60 [54, 66]; p=0.39). The simultaneous BRRD subgroup had a significantly higher myopia rate (simultaneous: 78% vs. sequential: 23%; p<0.001). Most patients (67%) diagnosed with simultaneous BRRD had unilateral symptoms only. Both groups combined, median [Q1, Q3] duration of symptoms was significantly shorter for the second eye compared to the first (first: 7 [3, 15] days vs. second: 4 [2, 10] days; p=0.028). Second eyes had less tears at the initial consultation compared to the first (first: 2 [1, 4] tears vs. second: 2 [1, 3] tears; p=0.031). Median [Q1, Q3] PHVA at presentation was better for the second eye (first: 0.46 [0.14, 2.30] vs. second: 0.24 [0.06, 0.95]; p=0.012). The proportion of macula-off presentation between the first and second eyes was not significantly different (first: n=56, 51% vs. second: n=44, 40%; p=0.11). SSAS was 92% (n=100) and 93% (n=101) for the first and second eye, respectively (p=1.00). Both eyes improved their visual acuity, PHVA at 3 months was comparable (first: 0.30 [0.14, 0.48] vs. second: 0.34 [0.13, 0.70]; p=0.36) and final VA was better for the first eye (first: 0.14 [0.04, 0.30] vs. second: 0.20 [0.04, 0.43]; p=0.010). Complication rates were 1% (n=1) and 1.8% (n=2) for the initial eye and the subsequent eye, respectfully (p=1.00). 

Conclusions: In this study of BRRD, SSAS was similar for both eyes. The subsequent eye was more likely to be treated earlier and to be less advanced on presentation, but at 3 months, PHVA was not significantly different between eyes. Difference in final PHVA may be attributable to longer follow-up in first eyes.