Clinical characteristics of rhegmatogenous retinal detachment in patients over 90 years in a tertiary center in Germany: 90-TOSG report 2.

Abstract

Purpose: This study aims to investigate the clinical characteristics of rhegmatogenous retinal detachment (RRD) in patients aged over 90 years, a demographic that has been underrepresented in previous research.

Method: Retrospective, single-center, observational case series. The study included patients over 90 years old, excluding those with significant ocular trauma or other specific eye diseases affecting the retina. Data on demographic characteristics, RRD extent, surgical interventions, and postoperative outcomes were collected and analyzed.

Results: The study included 24 patients (24 eyes, 75% female) where the median age was 93 years (range: 91-98). Most patients displayed macular involvement, and about one-third experienced proliferative vitreoretinopathy. Surgical interventions primarily involved pars plana vitrectomy, with a noted delay from symptom onset to surgery averaging ten days. Postoperative improvements in visual acuity were significant, yet the final visual acuity remained low. Baseline median BCVA was 2.30 logMAR, and 1.0 (0.30-2.30) log MAR at the last visit (p = 0.017). RRD was in 52% of the eyes over two quadrants, in 83.3% with macula involvement, and in 37.5% with proliferative vitreoretinopathy (PVR) at baseline. Of these patients, 61.9% were pseudophakic. Twenty-one eyes of 21 patients underwent treatment and postoperative follow-up was available in 47.6% (n = 10) of the patients. Four of the 10 patients with follow-up had redetachment at the last visit.

Conclusion: The high rate of macular involvement and the complexities associated with PVR highlight the challenges of treating RRD in the elderly. Delayed hospital presentation, impaired adherence to posturing and low postoperative follow-up rates may significantly impact the treatment success. This study underscores the need for tailored management strategies to improve outcomes in this age group.

Key messages: What is known An increase in retinal detachments has occurred mainly due to earlier lens surgery in the younger age group but will also occur in the old-aged group as a result of demographic changes. What is new Elderly patients show variable symptoms of retinal detachments and management is complicated by frequent ocular and systemic comorbidities. The clinical characteristics of detachments at age over 90 years include proliferative vitreoretinopathy and late presentation. Like vitreoretinal surgery at the end of life, the decision to operate presents a particular challenge.