Comparative prospective study of rhegmatogenous retinal detachments in phakic or pseudophakic patients with high myopia.

PURPOSE:To compare the anatomical and functional results of primary rhegmatogenous retinal detachment in highly myopic phakic or pseudophakic eyes. METHODS:This prospective 2-center study included 191 consecutive eyes (151 phakic and 40 pseudophakic eyes) from a prospective cohort of 835 patients (IRB #5891, between 2004 and 2008). Baseline and follow-up data were systematically recorded at presentation, 1 month, and 6 months or more after surgery. On final examination, two groups were considered based on the need for one or more surgeries to achieve retinal reapplication. End points were primary reattachment rate at the 6-month visit, final anatomical success rate, postoperative visual acuity, and intraoperative and postoperative complications. RESULTS:Pseudophakic eyes differed from phakic eyes in age (60.8 ± 10.4 vs. 49.9 ± 12.3, P < 0.001), smaller pupil dilation (8.0 ± 1.5 vs. 8.5 ± 1.2 mm, P = 0.02), fewer retinal tears seen preoperatively (1.5 ± 1.6 vs. 2.2 ± 2.2, P = 0.06), more frequent use of pars plana vitrectomy (80% vs. 28.5%, P < 0.001), and higher single reattachment rate (92.5% vs. 80.7%). Visual acuity was greater than or equal to 20/40 in 54% of cases with single retinal detachment surgery and 44% of cases with multiple surgeries. Multiple logistic regression analysis showed that only 3 independent variables were significantly predictive of good final visual acuity (20/40): initial visual acuity (<20/400, odds ratio = 0.19; 95% confidence interval, 0.07-0.51; P = 0.002), axial length (odds ratio = 0.57; 95% confidence interval, 0.44-0.75, P < 0.001), and pars plana vitrectomy (odds ratio = 0.33; 95% confidence interval, 0.15-0.71, P = 0.004). CONCLUSION:This prospective study showed similar baseline retinal detachment characteristics of high myopic phakic or pseudophakic eyes, suggesting that high myopia was the main pathogenic factor in both groups. Although high myopic eye presents anatomical characteristics that could favor surgical morbidity, these recent prospective data show that high myopic eyes exhibit functional and anatomical prognosis close to that described in emmetropic eyes.