We read with interest the recent issue of _Eye_ (July 2002) that included the papers of the Cambridge Ophthalmological Symposium on the various aspects of retinal detachment. In particular,

the editorial by Scott1 and the article by Asaria and Gregor2 caught our interest. It seems now an accepted practice that all retinal detachment surgery is performed in tertiary referral

centres or by vitreoretinal surgeons carrying out surgery in district general hospitals. In this light, we would like to share with your readers the results of an audit carried out in a

district general hospital on the outcome of primary retinal detachment surgery performed by general ophthalmologists. This audit coincidentally preceded a decision by the department to refer

placement of explants with or without subretinal fluid drainage. Air injection was carried out if necessary. In those patients who underwent repeat surgery, a similar surgical approach was

adopted. Successful reattachment was achieved in 47 eyes (81%) after one procedure. Repeat surgery in the department resulted in reattachment in a further five eyes. The overall anatomical

success rate was thus 90%. In 10 patients who had retinal dialysis, the primary success rate was 100%. The visual acuity improved in 33 eyes (63.5%), remained unchanged in 11 eyes (21%) and

was worse after surgery in eight eyes (15.5%). Primary surgery was not successful in 11 eyes of 11 patients, of whom one refused further surgery. Five patients had their retina reattached

after further surgery within the department and five others were referred to the regional vitreoretinal unit. Sullivan _et al_3 suggest 75% to be a reasonable goal for primary success rate.

Snead and Scott4 question this recommendation and suggest that the goal should be nearer 90%. They quote their audit results, which showed that the results of surgery carried out by juniors

improved from 78% operating alone to 94% when operating under consultant supervision. The results of our audit suggest that these patients are likely to be a group of selected patients

possibly with low-risk retinal detachments. This bias is likely to have resulted in the above good results. It is also less likely that specialist registrars of the recent years have

undergone sufficient training to embark on specialised procedures like retinal detachment surgery. Evidence in the literature also suggests that the results are likely to be better if all

retinal detachment surgery is carried out in a vitreoretinal unit.5 The current practice of the department in referring all patients with retinal detachment to the regional vitreoretinal

centre is likely to benefit the patients and ensure good anatomical and visual outcome. REFERENCES * Scott JD . Future perspectives in primary retinal detachment repair. _Eye_ 2002; 16:

349–352. Article  CAS  Google Scholar  * Asaria RHY, Gregor ZJ . Simple retinal detachments: identifying the at-risk case. _Eye_ 2002; 16: 404–410. Article  CAS  Google Scholar  * Sullivan

PM, Luff AJ, Aylward GW . Results of primary retinal reattachment surgery: a prospective audit. _Eye_ 1997; 11: 869–871. Article  Google Scholar  * Snead MP, Scott JD . Results of primary

retinal reattachment surgery: a prospective audit, (letter). _Eye_ 1998; 12: 750. Article  Google Scholar  * Comer MB, Newman DK, George ND, Martin KR, Tom BD, Moore AT . Who should manage

primary retinal detachments? _Eye_ 2000; 14: 572–578. Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Ophthalmology, Royal

Hallamshire Hospital, Sheffield, S10 2JF, UK S Dinakaran * Department of Ophthalmology, Doncaster Royal Infirmary, Doncaster, DN2 5LT, UK S P Desai, L R Kolli, P J Noble & V V Kayarkar

Authors * S Dinakaran View author publications You can also search for this author inPubMed Google Scholar * S P Desai View author publications You can also search for this author inPubMed 

Google Scholar * L R Kolli View author publications You can also search for this author inPubMed Google Scholar * P J Noble View author publications You can also search for this author

inPubMed Google Scholar * V V Kayarkar View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to S Dinakaran. RIGHTS AND

PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Dinakaran, S., Desai, S., Kolli, L. _et al._ Primary retinal detachment surgery. _Eye_ 17, 547–548 (2003).

https://doi.org/10.1038/sj.eye.6700406 Download citation * Published: 15 May 2003 * Issue Date: 01 May 2003 * DOI: https://doi.org/10.1038/sj.eye.6700406 SHARE THIS ARTICLE Anyone you share

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