CHARACTERISTICS OF

RHEGMATOGENOUS RETINAL
DETACHMENT AND THEIR
RELATIONSHIP TO SUCCESS RATES
OF SURGERY
TOM H. WILLIAMSON, MD, FRCOPHTH, EDWARD J. K. LEE, PHD, FRCOPHTH,
MANOHARAN SHUNMUGAM, MBCHB, FRCOPHTH

Purpose: To determine features of rhegmatogenous retinal detachment predictive of

anatomical success with surgical procedure.
Methods: All patients undergoing surgery at a tertiary referral practice had contempo-
raneous data collection in an electronic database. Overall, 847 eyes from 847 patients
undergoing surgical procedure for rhegmatogenous retinal detachment were included in
this study.
Results: Mean age was 62.2 years with 60% male subjects and 56% right eyes. Mean
postoperative follow-up was 9.6 months (range, 6 weeks to 10 years). With univariate
analysis, the presence of superotemporal breaks was associated with a reduction in the
chance of failed primary surgery (P = 0.005); detached inferonasal breaks (P = 0.002),
proliferative vitreoretinopathy (PVR) (P , 0.0001), breaks in detached inferior retina
(P , 0.0001), fovea off (P = 0.001), and 4-quadrant rhegmatogenous retinal detachment
(P , 0.0001) increased the risk of failure. After multivariate analysis PVR, detached inferior
breaks, increased number of breaks, and 4-quadrant detachment remained associated with
an increased risk of failure, and superotemporal detached breaks with the reduced risk of
failure (r2 = 0.08). For patients without PVR, only inferonasal detached breaks and 3 to 4
quadrants of detachment remained predictive of failure (r2 = 0.04). For patients with PVR (n
= 120), multivariate analysis showed that PVR C4-12 and posterior breaks increased the
failure risk and detached superotemporal breaks reduced the risk of failure (r2 = 0.22).
Conclusion: Number of breaks, inferior positioning of breaks, the extent of rhegmatog-
enous retinal detachment, and PVR are associated with failed primary surgery.
RETINA 34:1421–1427, 2014

T he influence of rhegmatogenous retinal detachment

(RRD) features in determining the success rates of
surgery is not fully understood. Rhegmatogenous retinal
detachment may present with many patterns of breaks,
varying extent of RRD, and the presence of proliferative
vitreoretinopathy (PVR). Some of these have been
studied in older publications, but historical studies
have used ophthalmoscopy to determine clinical
From the Department of Ophthalmology, St Thomas’ Hospital,
London, United Kingdom.
None of the authors have any conflicting interests to disclose.
Supported by Eyehope (UK registered charity 1119866).
Reprint requests: Tom H. Williamson, MD, FRCO PHTH,
St Thomas’ Hospital, Lambeth Palace Road, London, United
Kingdom SE1 7EH; e-mail: Tom@retinasurgery.co.uk
characteristics with many breaks likely to be missed,
reflected in high rates of eyes (10%) in which no breaks
are found.1,2 The advent of wide-angle viewing systems
and the increased use of pars plana vitrectomy allow
a more detailed examination of the retina. This, in addi-
tion to the use of digital recording of data with the use
of digital drawings, has provided an opportunity to
examine these cases more thoroughly. An understand-
ing of the pattern of clinical features of RRD is essential
if surgeons are to be able to maximize the success of
operations. We have previously used a data set of
detailed descriptions of RRD characteristics to show
that pseudophakic RRD has a differing pattern of

1421
1422 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES
presentation to nonpseudophakic RRD and that it
shares similarities to aphakic RRD.3
Primary success rates vary from 81% to 92% in
uncomplicated cases,4–10 65% to 70% in high-risk
eyes, or 75% when no break is found.5,11–15 This in-
dicates that there is a significant failure rate of single
surgery in RRD with many patients requiring second
or even multiple surgeries. Despite great advances
in surgical method, a final failure rate persists.
Therefore, it is important for the surgeon to iden-
tify patients who are at a high risk of failure. In this
study, the preoperative characteristics of RRD
were studied in relation to the success rates of
reattachment RRD to try to determine if clinical
features could identify those at the risk of failure
of primary surgery.
Methods
Data from all patients attending the vitreoretinal
surgery service of one of the authors (T.H.W.) were
prospectively entered into an electronic patient record
(VITREOR, Microsoft Access, available with the book
by Williamson).16 The electronic patient record requires
recording of retinal detachment characteristics and
digital drawings of the RRD. The duration of symp-
toms, type of breaks, number of breaks, presence of
proliferative vitreoretinopathy according to the revised
Retinal Society classification,17 extent of retinal detach-
ment, foveal status, presence of vitreous hemorrhage,
and visual acuity (determined using Snellen charts but
converted to logarithm of the minimum angle of reso-
lution) were recorded. In addition, data on the status of
the lens (including the presence of visually significant
cataract or pseudophakia) and date of previous cataract
surgery were recorded. Retinal breaks were classi-
fied as U shaped, round (including oval), or mixed.
Ethical approval for the database study was obtained
from the local research ethics committee (Guys and
St Thomas’ Hospitals Trust).
For patients who developed RRD in both eyes,
only the first eye was included in the present study.
Patients younger than 40 years (to avoid the influence
of RRD from young myopes with atrophic holes and
vitreous attached) or with aphakia, anterior chamber
lens implant, giant retinal tear, retinal dialysis, macular
hole–related RRD, retinoschisis-related RRD, and dislo-
cated lens nucleus during cataract surgery were excluded.
Retinal drawings were reviewed by an observer
(T.H.W.) who was masked to the clinical data of the
patient. Drawings were divided into four quadrants
centered at the fovea: superotemporal, superonasal,
inferotemporal, and inferonasal. The observer recorded

2014
VOLUME 34
NUMBER 7
whether the eye had any breaks (true or false) in any of
the four quadrants. This method was used to avoid any
conflict of dependant variables that would arise by
counting the numbers of breaks in each quadrant and
using these as independent variables, a procedure which
has been used in previous studies,1,2 resulting in
erroneous statistical analysis, as multiple breaks in
the same eye are not independent variables. The pres-
ence of inferior breaks was recorded, specifically noting
whether breaks were present between 5- and 7-o’clock
position (true or false) or between 4- and 5-o’clock or
7- and 8-o’clock position (true or false), and whether
these were in flat or detached retina. Such breaks can
present particular challenges in surgical management,
compared with breaks elsewhere; hence, this subdi-
vision was not applied to superior, nasal, or temporal
breaks. Eyes were regarded as having an anterior
break if a break was identified anterior to a line halfway
between the equator and the ora serrata. Eyes had a pos-
terior break if a break was seen posterior to this line.
In addition, breaks were regarded as small, medium,
and large according to their longest meridian and in
comparison to the optic disk diameter. A small break
was defined as less than half a disk diameter; medium
break size was 0.5 disk diameters to 2 disk diameters;
and large was more than 2 disk diameters. Eyes were
recorded (true or false) as having small, medium, or
large breaks. Thus, a single eye could have small,
medium, and large breaks if all sizes were present.
Success was defined in three categories at the final
follow-up and required resolution of the gas bubble or
a minimum of 6 weeks of follow-up:
1. Primary success with a fully attached retina without
intraocular tamponade with one planned procedure
(excluding oil removal) or two procedures if a
planned delayed retinectomy was performed for
PVR.18
2. Secondary success when a fully attached retina
even with silicone oil in situ was achieved outside
those parameters described in the above category.
3. Final failure with any area of retinal detachment at
the final follow-up.
For most of the statistical comparisons, Categories
1 and 2 (primary success) have been compared with a
combination of both 2 and 3 (primary failure).
Data were analyzed using statistical software for
univariate analysis (Analyse-it; Analyse-it Soft-
ware Ltd., Leeds, United Kingdom) and multivar-
iate analysis (Statplus; Analystsoft, Alexandria,
VA). Mean values were compared using the t-test,
medians by nonparametric methods, and propor-
tions using Fisher’s exact test or Pearson’s chi-
square test.
 PREDICTING SUCCESS OF RRD SURGERY
WILLIAMSON ET AL 1423

Results Table 2. Characteristic of Retinal Breaks Determined

From a Retrospective Masked Review of Digital Drawings
of the RRD
Overall, 847 eyes from 847 patients were
included in the study. Mean age was 62.2 years Variable Count Percentage
(range, 40–97 years) with 60% male subjects and Break size
56% right eyes. Mean follow-up was 9.6 months Small 359 42.4
(range, 6 weeks to 10 years). Median number of Medium 503 59.4
breaks was 2, with the mean preoperative visual acuity Large 177 20.9
in logarithm of the minimum angle of resolution being Superotemporal 582 68.7
Inferotemporal 274 32.3
0.93 (standard deviation, 0.86). Mean spherical equiv- Superonasal 341 40.3
alent was −1.77 diopters (range, −18.25 to 4 diopters). Inferonasal 144 17.0
Descriptive data of the patients at presentation are pro- Superotemporal attached 44 5.2
vided in Tables 1 and 2. Approximately 26 patients had Superotemporal detached 536 63.3
primary silicone oil insertion with planned delayed Inferotemporal attached 68 8.0
Inferotemporal detached 222 26.2
retinectomies. Superonasal attached 80 9.4
Using univariate analysis, some variables were asso- Superonasal detached 294 34.7
ciated with primary success (Table 3). The presence of Inferonasal attached 63 7.4
Inferonasal detached 95 11.2
Anterior 211 24.9
Posterior 120 14.2
Table 1. Data Entered Into the RRD Data Set 4- to 5- and 7- to 8-clock hours flat 35 4.1
Prospectively at the Time of First Surgery, and the Type of breaks
Primary Surgery Performed 5- to 7-clock hours flat breaks 62 7.3
4- to 5- and 7- to 8-clock hours 90 10.6
Variable Count Percentage
breaks in RRD
Male 509 60.1 5- to 7-clock hours breaks in RRD 86 10.2
Female 338 39.9
Right eye 471 55.6
Left eye 376 44.4
Normal crystalline lens 329 38.8 superotemporal breaks was associated with a reduction
Cortical cataract 49 5.8 in the chance of failed primary procedure. Inferonasal
Mixed cataract 22 2.6
Nuclear sclerotic cataract 179 21.1 breaks were associated with an increased risk of failure.
Posterior chamber intraocular lens 253 29.9 Increased number of breaks increased the chance of
Posterior subcapsular cataract 15 1.8 failure (Figure 1).
Vitreous hemorrhage The presence of PVR increased the risk of failure
Mild 66 7.8 (Table 3). Patients without PVR had a primary success
Moderate 29 3.4
Severe 6 0.7 rate of 90.1%, secondary success of 8.3%, and final
Fovea off 477 56.3 failure rate of 1.6%. Patients with PVR had a primary
Posterior vitreous detachment 758 89.5 success rate of 68.3%, secondary success of 21.7%,
Breaks and final failure of 10%. Breaks in detached retina in
Nil identified 16 0.4 the inferior clock hours 4 to 8, fovea off, and the extent
Mixed 164 19.3
Round hole(s) 88 10.4 of RRD all increased the risk of failure. Visual acuity
U tear(s) 592 69.9 at presentation was worse in patients with primary
Quadrants of RRD failure (Figure 2).
1 175 24.4 Patients with primary failure were slightly less myopic
2 301 35.5 by spherical equivalent. The presence of inferior breaks
3 228 26.9
4 112 13.2 in detached retina was more likely in those with primary
PVR Grade B 71 8.4 failure, for breaks in 4- and 5-o’clock hours and 7- and
PVR Grades B or C 120 14.2 8-o’clock hours and 5- to 7-o’clock hours. Flat breaks
Surgery performed in the same areas had no effect.
DACE 3 0.4 After multivariate analysis, PVR, detached breaks at
Cryo-buckle 81 9.6
PPV (7.3% of PPV had scleral 763 90.1 5- to 7-o’clock hours, increased number of breaks, and
buckle insertion and 8.4% had total retinal detachment (4 quadrants of detached retina)
silicone oil tamponade) remained significantly associated with increased failed
DACE, drain, air, cryotherapy and explant; PPV, pars plana primary surgery (Figure 3). The presence of super-
vitrectomy. otemporal detached breaks reduced the rate of failure.
1424 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES
2014
VOLUME 34
NUMBER 7

Table 3. Univariate Analysis of Variables Significantly Associated With Primary Success/Failure, Presented for All Eyes
and Separately for Eyes With No PVR
Primary Success (%)
With Without Relative 95% Confidence
Variable Variable Risk Interval P
All eyes
Superotemporal breaks 89.3 81.9 0.675 0.531–0.858 0.005
Superotemporal detached breaks 89.1 83.3 0.934 0.881–0.989 0.02
Inferonasal breaks 78.5 88.8 1.179 1.045–1.331 0.002
Inferonasal detached breaks 75.8 88.4 1.167 1.038–1.311 0.002
PVR 68.33 90.10 1.318 1.165–1.149 ,0.0001
Breaks at clock hours 4–5 and 7–8 78.9 88.0 1.115 0.999–1.245 0.031
(detached)
Breaks 5–7 detached 70.9 88.8 1.252 1.091–1.437 ,0.0001
Fovea off 83.6 91.3 1.092 1.038–1.149 0.001
Quadrants 2, 3, 4 vs. 1 85.2 92.0 1.089 1.035–1.144 0.005
Quadrants 3, 4 vs. 1, 2 79.7 91.6 1.153 1.087–1.224 ,0.0001
Quadrants 4 vs. 1, 2, 3 68.8 89.7 1.306 1.150–1.483 ,0.0001
No PVR
Inferonasal detached breaks 80.8 91.1 1.128 1.006–1.264 0.02
Breaks 5–7 detached 70.9 91.3 1.197 1.036–1.383 0.002
Quadrants 3, 4 vs. 1, 2 85.9 92.1 1.072 1.013–1.135 0.01

A simplified model can be used with the presence of with median 0.18 (quartiles, 0.18–0.48) and median
some of these variables, with r2 = 0.08: 0.78 (quartiles, 0.18–1.85), respectively (P , 0.0001).

Primary  failure ¼ 1:0811 þ ð0:1432 · PVRÞ

þ ð0:1278 · breaks  at  5-  to  Analysis of Patients Without
7-clock  hours  in  RRDÞ
þ ð0:1175 · RRD  of  quadrants  4Þ
At the final follow-up, 2.8% of patients had per-
sistent RRD present somewhere in the eye, 6% had
silicone oil in the eye, and 2 patients had hypotony.
Mean visual acuity at follow-up was 0.32 (standard
deviation, 0.4) in those with primary success and 0.96
(standard deviation, 0.4) in those with primary failure,
Proliferative Vitreoretinopathy
Patients without PVR were also analyzed separately.
Fewer variables were predictive of primary failure,
namely, inferonasal detached breaks, breaks in 5- to
7-’oclock hours, which were detached, 3 or 4 quadrants
of detachment, number of breaks, and spherical equiva-
lent (less myopic) (Tables 3 and 4). Multivariate analysis
showed that only inferonasal detached breaks and the

Fig. 1. Bar diagram showing the increasing proportion of failed pri-

mary surgeries (Series 2) compared with successful primary surgeries Fig. 2. Box-plot showing visual acuity in patients with primary success
(Series 1) with breaks numbering 1, 2, 3, 4, and 5 and more. rates and primary failure. CI, confidence interval.
 PREDICTING SUCCESS OF RRD SURGERY
WILLIAMSON ET AL 1425

Primary  failure ¼ 1:0319 þ ð0:3147 · PVR  C4-12Þ

−ð0:2401 · superotemporal  detached  breaksÞ
þ ð0:2545 · posterior  breaksÞ

Discussion

This study provides detailed information on the

Fig. 3. The proportions of primary success, secondary success, and
final failure are shown as a function of quadrants of detachment and
severity of PVR.
presence of 3 or 4 quadrants of detachment remained
predictive at r2 of only 0.04.
Analysis of Patients With
Proliferative Vitreoretinopathy
Using univariate analysis, superotemporal and
superotemporal detached breaks were associated with
an increased chance of primary success. Inferonasal
breaks, posterior breaks, and 4 quadrants of RRD
increased the chance of primary failure.
After multivariate analysis, PVR C4-12 and posterior
breaks increased the chance of failure and detached
superotemporal breaks reduced the chance of failure
(r2 = 0.22) (Figure 3 and Table 5). A predictive model
can be used with the presence of these variables:
location, number, and characteristics of breaks and
other features of RRD in a population of patients older
than 40 years presenting with RRD without previous
vitreoretinal surgery. We confirm a male sex bias and
more right eyes affected.19 Retinal breaks are only
rarely not found (0.4%) because of the advent of supe-
rior methods for visualization of the retina in the mod-
ern era. Various details of the size, shape, and location
of breaks have been elucidated, with 68.7% of eyes
having superotemporal retinal breaks (most of which
are detached) and 17.0% having inferonasal breaks,
which have more chance of being attached. We found
20.8% of eyes had breaks in the lower clock hours in
detached retina. Proliferative vitreoretinopathy was
seen in 14.2% at presentation, which is higher than
some estimates of PVR in other western countries, for
example, 7% PVR Grade B or C in Scotland.20 This
may reflect the different population demography of
London and its multiethnic constitution and a reduction
in the rapid utilization of health care in the metropolis.
In this study, an attempt was made to find features
of retinal detachment, which could guide the surgeon
to a high risk of failure. Previous investigators have
indicated that PVR is the most predictive factor in
the eye at presentation.21 This study confirms PVR as
the most predictive variable for failure of primary surgery,
with the patients without PVR having primary success
of 90.1% and those with PVR having a primary suc-
cess rate of 68.3%. Proliferative vitreoretinopathy was
also found to be more likely to be associated with final
failure. At the initial presentation, in patients without
PVR, the rate of failure was 1.6%; however, in those
with PVR at presentation, this was 10%. The grades of
PVR were related to failure particularly at the higher

Table 4. Univariate Analysis of Eyes Without PVR

Primary Success Mean Primary Failure Mean Primary Success Primary Failure
(Standard Deviation) (Standard Deviation) Median (Quartiles) Median (Quartiles) P
Number of 2.7 (2.3) 3.5 (2.7) 2.0 (1.0 to 3.0) 3.0 (1.0 to 5.0) 0.006
breaks
Spherical −1.99 (3.1) −1.55 (3.0) 0 (−3.2 to 0.0) 0 (−3.0 to 0.0) 0.05
equivalent
Visual acuity 0.28 (0.38) 0.75 (0.76) 0.18 (0.0 to 0.48) 0.30 (0.18 to 0.48) ,0.0001
at follow-up
1426 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES
Table 5. Univariate Analysis of Eyes With PVR
Primary Success With Primary Success Without
Variable, %
Superotemporal 78.08
Superotemporal 79.17
detached breaks
Inferonasal 48.00
Posterior 48.00
Quadrants 4 vs. 1, 2, 3 58.46
PVR C4-12 38.1
end of C-grade PVR; however, B-grade PVR was also
associated with failure and has not often been included
in previous studies, despite B-grade PVR being shown
to increase the chance of severe postoperative PVR.22
Unlike Wickham et al,21 we did not find previous
lens status or vitreous hemorrhage as risk factors but
instead found that the position of the retinal breaks
was important with superotemporal breaks protective
and breaks in the 5- to 7-o’clock hours detrimental on
multivariate analysis. We confirm that the increased
number of quadrants of RRD increases the chance of
failure but found that a greater number of breaks is
also important. A simplified model of presence of
PVR, breaks in the 5- to 7-o’clock hours, and 4 quadrant
RRD can be used with an r2 value of 0.08 to assess risk,
but other unknown factors unaccounted for in this model
may be of greater importance.
An analysis of only those patients without PVR
showed that it was harder to predict failure with
variables contributing only 4% to the chance of failure.
The presence of detached inferonasal breaks and a
greater than 50% area of RRD were weakly associated
with failure. With the exception of PVR, therefore, it is
difficult for the surgeon to maximize surgical success
further by the observation of preoperative retinal
features and changing the surgical strategy from that
used. Other factors must come into play either
perioperatively or postoperatively, which explain the
failure of surgery.
When examining only those patients with PVR, the
grade of PVR was important and especially so when in
the group with C4-12 PVR. However, other features
that have not previously been identified influenced the
outcome with posteriorly placed breaks detrimental
and superotemporal detached breaks protective. It is
speculative to describe why this might be with super-
otemporal breaks perhaps indicating a simpler RRD
configuration and posterior breaks perhaps being more
involved in the PVR process. Whatever the reasons,
a surgeon can be aware that these variables contribute
to 22% of the risk of failure.
Our success rates of the surgical procedure were com-
parable to others.23–27 Our surgical approach involved

2014
VOLUME 34
NUMBER 7
Relative 95% Confidence
Variable, % Risk Interval P
53.19 0.527 0.344–0.805 0.008
52.94 0.664 0.500–0.883 0.004
73.68 1.298 1.014–1.660 0.03
73.68 1.53 1.003–2.349 0.03
80.00 1.37 1.07–1.75 0.019
73.3 1.37 1.08–1.74 0.003
pars plana vitrectomy in most cases. An investigation
of other factors in the surgical process will be required
to try to identify other risk factors. However, apart
from taking into consideration some of the variables
described, and particularly the presence of PVR, it is
difficult for the surgeon to alter the technique given the
preoperative and perioperative features of the RRD.
The configurations of the RRD seen here can be a guide
to the surgeon to the possible risk of failure, especially
when PVR is present, for example, posterior breaks.
Whether surgical method can be altered is uncertain.
In conclusion, preoperative PVR remains the most
predictive risk factor for the failure of primary RRD
repair. Other factors related to position of retinal break
and the extent of RRD have a role to play. In RRD
without PVR, it is difficult to predict failure from pre-
operative features to a significant degree. New features
have been identified as additional risk factors in PVR.
Key words: rhegmatogenous retinal detachment,
retinal break, pseudophakia.
References
1. Phillips CI. Distribution of breaks in aphakic and “senile” eyes
with retinal detachments. Br J Ophthalmol 1963;47:744–752.
2. Ashrafzadeh MT, Schepens CL, Elzeneiny II, et al. Aphakic
and phakic retinal detachment. I. Preoperative findings. Arch
Ophthalmol 1973;89:476–483.
3. Mahroo OA, Dybowski R, Wong R, et al. Characteristics of
rhegmatogenous retinal detachment in pseudophakic and
phakic eyes. Eye (Lond) 2012;26:1114–1121.
4. Ah-Fat FG, Sharma MC, Majid MA, et al. Trends in vitreoretinal
surgery at a tertiary referral centre: 1987 to 1996. Br J Ophthalmol
1999;83:396–398.
5. Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy
without scleral buckle for pseudophakic retinal detachments.
Ophthalmology 1999;106:1811–1815.
6. Girard P, Karpouzas I. Pseudophakic retinal detachment: anatomic
and visual results. Graefes Arch Clin Exp Ophthalmol 1995;233:
324–330.
7. La Heij EC, Derhaag PF, Hendrikse F. Results of scleral
buckling operations in primary rhegmatogenous retinal
detachment. Doc Ophthalmol 2000;100:17–25.
8. Oshima Y, Emi K, Motokura M, et al. Survey of surgical
indications and results of primary pars plana vitrectomy for
rhegmatogenous retinal detachments. Jpn J Ophthalmol 1999;
43:120–126.
 PREDICTING SUCCESS OF RRD SURGERY
WILLIAMSON ET AL
9. Thompson JA, Snead MP, Billington BM, et al. National audit
of the outcome of primary surgery for rhegmatogenous retinal
detachment. II. Clinical outcomes. Eye (Lond) 2002;16:
771–777.
10. Minihan M, Tanner V, Williamson TH. Primary rhegmatogenous
retinal detachment: 20 years of change. Br J Ophthalmol 2001;85:
546–548.
11. Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for
rhegmatogenous retinal detachment. Graefes Arch Clin Exp
Ophthalmol 1993;231:344–346.
12. Heimann H, Bornfeld N, Friedrichs W, et al. Primary vitrectomy
without scleral buckling for rhegmatogenous retinal detachment.
Graefes Arch Clin Exp Ophthalmol 1996;234:561–568.
13. Schmidt JC, Rodrigues EB, Hoerle S, et al. Primary vitrectomy
in complicated rhegmatogenous retinal detachment—a survey
of 205 eyes. Ophthalmologica 2003;217:387–392.
14. Tewari HK, Kedar S, Kumar A, et al. Comparison of scleral
buckling with combined scleral buckling and pars plana vitrec-
tomy in the management of rhegmatogenous retinal detachment
with unseen retinal breaks. Clin Experiment Ophthalmol 2003;
31:403–407.
15. Wong D, Billington BM, Chignell AH. Pars plana vitrectomy
for retinal detachment with unseen retinal holes. Graefes Arch
Clin Exp Ophthalmol 1987;225:269–271.
16. Williamson TH. Vitreoretinal Surgery. Berlin, Germany:
Springer; 2008.
17. Machemer R, Aaberg TM, Freeman HM, et al. An updated
classification of retinal detachment with proliferative vitreore-
tinopathy. Am J Ophthalmol 1991;112:159–165.
18. Williamson TH, Gupta B. Planned delayed relaxing retinotomy
for proliferative vitreoretinopathy. Ophthalmic Surg Lasers
Imaging 2010;41:31–34.
1427
19. Mitry D, Tuft S, McLeod D, et al. Laterality and gender
imbalances in retinal detachment. Graefes Arch Clin Exp
Ophthalmol 2011;249:1109–1110.
20. Mitry D, Singh J, Yorston D, et al. The predisposing pathology
and clinical characteristics in the Scottish retinal detachment
study. Ophthalmology 2011;118:1429–1434.
21. Wickham L, Bunce C, Wong D, et al. Retinal detachment
repair by vitrectomy: simplified formulae to estimate the risk
of failure. Br J Ophthalmol 2011;95:1239–1244.
22. Bonnet M, Guenoun S. Surgical risk factors for severe post-
operative proliferative vitreoretinopathy (PVR) in retinal
detachment with grade B PVR. Graefes Arch Clin Exp
Ophthalmol 1995;233:789–791.
23. Doyle E, Herbert EN, Bunce C, et al. How effective is macula-off
retinal detachment surgery. Might good outcome be predicted?
Eye (Lond) 2007;21:534–540.
24. Miki D, Hida T, Hotta K, et al. Comparison of scleral buck-
ling and vitrectomy for retinal detachment resulting from
flap tears in superior quadrants. Jpn J Ophthalmol 2001;
45:187–191.
25. Oshima Y, Yamanishi S, Sawa M, et al. Two-year follow-up
study comparing primary vitrectomy with scleral buckling
for macula-off rhegmatogenous retinal detachment. Jpn J
Ophthalmol 2000;44:538–549.
26. Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual
outcomes of scleral buckling versus primary vitrectomy in pseu-
dophakic and aphakic retinal detachment: six-month follow-up
results of a single operation—report no. 1. Ophthalmology
2005;112:1421–1429.
27. Day S, Grossman DS, Mruthyunjaya P, et al. One-year outcomes
after retinal detachment surgery among Medicare beneficiaries.
Am J Ophthalmol 2010;150:338–345.