Retinal detachment in Nigerians: a multicentre cross-sectional study on demographics, risk factors for blindness and surgical outcomes in a developing country.

OBJECTIVE

To compare the presenting demographic and clinical characteristics of rhegmatogenous retinal detachment (RRD) with other RD types, investigate risk factors of blinding RD and the outcome of surgical intervention.

DESIGN

Prospective, cross-sectional and multicentre.

SETTING

Four ophthalmic centres in three geographic locations of Nigeria.

PARTICIPANTS

264 eyes from 237 patients diagnosed with RRD, tractional retinal detachment (TRD) and exudative retinal detachment (ERD) seen between April 2019 and March 2020.

RESULTS

264 eyes of 237 patients were diagnosed out of 35 641 patients screened. RRD was the most common RD (n=167 (70.5%), TRD 61 (25.7%) and ERD 9 (3.8%) patients). The hospital-based prevalence of all RD is 6.6 per 1000 patients (0.66%), and for RRD alone, 4.7 per 1000 patients (0.47%). The most common symptom was a sudden decline in vision, 100 patients (42.2%); floaters and flashes were uncommon, 5 (2.1%). RRD presented earliest, with a median symptom duration of 2 months, and TRD and ERD at 7.5 months each.The 46-65-year age group had the highest representation, RRD (n=70, 41.9%), TRD (n=41, 67.3%), ERD (n=4, 44.4%). The mean age was highest in TRD (52.3±12.7 years) and lowest in RRD (44.0±17.5 years) and ERD (45.2±20.4 years). Males dominated (RRD 70.1%, TRD 62.3%, and ERD 66.7%). Ocular trauma was highest in RRD 29.3%, TRD 7.5% and ERD 10%; fellow eye RD was highest in TRD 47.5%, ERD 20%, RRD 8% and myopia was highest in RRD 27.6%.Two-thirds of eyes were blind (Snellen best-corrected visual acuity <3/60). Risk factors are prolonged symptom duration (p=0.03), ocular surgery (cataract surgery) (p=0.04), extent of RD (p=<0.001), increased quadrants of RRD (p=<0.001), macula involvement (p=<0.001), advanced proliferative vitreoretinopathy grade (p<0.004) and lattice degeneration (p<0.03). For all RD, previous intraocular surgery increased the risk of blindness by 2.1 times. Total RD raised the odds of blindness more than 16-fold. Involvement of more quadrants by RD increased the risk by 12 times compared with single-quadrant RD. Macular off RD had an 18-fold higher likelihood of blindness than macular on. Each additional year of age and each extra month of symptom duration increased the risk of blindness by 1.0%. Symptoms lasting over 6 months doubled the odds of blindness.Shorter symptom duration is associated with better preoperative and postoperative vision. In contrast, longer durations are connected to poorer outcomes. Eyes with symptoms lasting less than a week had a 17% rate of postoperative blindness, compared with 30% in cases lasting 1-3 months, and 51% in cases exceeding 6 months.

CONCLUSIONS

Delays in diagnosing and treating RD result in high rates of preoperative blindness, which can be reversed with surgery even after several weeks of symptoms. Understanding the associations between RD and the risk of blinding RD in developing countries will benefit early diagnosis, treatment and improve treatment outcomes.