Epidemiolgy of Rhegmatogenous Retinal Detachment in Dubrovnik-Neretva County

Aim: This study is the fi rst examination of the incidence of rhegmatogenous retinal detachment (RRD) in DubrovnikNeretva County, Croatia. Method: Study is a retrospective and analyzed documentation from the Retinal clinic of the Ophthalmology and Optometry Department of the General Hospital Dubrovnik. The annual incidence was calculated and analyzed in relation to sex, age, diagnosis year, affected eye, and visual acuity on diagnosis, visual acuity after therapy, type of therapy, localization of retinal detachment, risk factors, second eye rupture, redetachment, and presence of comorbidity. Results: This study presents 92 examiners (94 eyes) who were in the period 1.1.2004 to 31.12.2013 diagnosed with the RRD. The youngest patient was 24 years old and the oldest 86 years. The largest number of cases was in the older age groups (61-70 years), at the age 60 to 80 there were 54 patients (57. 45%). The average age of all patients was 61.14 years. The average annual number of patients was 9.4. Surgical procedure vitrectomy was performed for 82 (87.23%) patients, 8 (8.5%) had an operation with conventional ablation with cerclage and sealing, and 4 of them (4.27%) did not undergo surgery, due to high level of retinal detachment or older age, comorbidity and high risk of general anesthesia. Conclusion: The incidence of RRD in this study shows 7.65 on 100, 000 residents of DubrovnikNeretva County, and it is found to increase last years (2013 was 21 RRD) and in associations with myopia, cataract surgery and trauma. Research Article Epidemiolgy of Rhegmatogenous Retinal Detachment in DubrovnikNeretva County Ivana Carevic1, Antonela Gverovic Antunica1*, Helena Kastelan1, Vedrana Iveta2, Sanja Zoranic3 and Snjezana Kastelan4 1Department of Ophthalmology and Optometry, General Hospital Dubrovnik, Dr. Roka Mišetića 2, 20000 Dubrovnik, Croatia 2Medical Centre Dubrovnik, Dr. Ante Starčevićeva 1, 20000 Dubrovnik, Croatia 3University of Dubrovnik Ul. BraniteljaDubrovnika 29, 20000 Dubrovnik, Croatia 4Department of Ophthalmology, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia Received: 27 July, 2018 Accepted: 20 August, 2018 Published: 21 August, 2018 *Corresponding author: Antonela Gverović Antunica, Department of Ophthalmology and Optometry, General Hospital Dubrovnik, Dr. Roka Mišetića 2, 20000 Dubrovnik, Croatia, Email id:


Introduction
Retinal detachment is eye disorder in which the retina separates from the layer underneath [1,2]. There are 4 types of retinal detachment: rhegmatogenous, tractional, exudative, and solid retinal detachment. RRD is a result of a full-thickness defect of the sensory retina through which the diluted vitreous gel passes into the sub retinal space and drains the retina [3].
The fi rst symptoms appear as lightning fl ashes, and if there is a rupture near the blood vessels and bleeding occurs, there are visible dark fl oating spots that decrease visual acuity depending on the amount of blood. The marked decline in visual acuity occurs when macula is affected [4].
Laser and freezing treatment procedures can repair a tear if it is diagnosed early enough. In pneumatic retinopexy the gas bubble is injected into the vitreous, while scleral buckle and vitrectomy are surgical procedures [5].
It is necessary to detect retinal detachment as soon as possible, because early onset therapy provides good success.
In this study we analyzed ten years epidemiological status and treatment results in Dubrovnik-Neretva County. In average, women were slightly younger than men ( Visual acuity in patients which had not done the surgery was as expected worse. Table 2 shows compared visual acuity before and after the treatment against risk factors. In all groups except those with a risk factor of trauma, visual acuity improved.

Methods
The study is retrospective, and from the archives of the Retinal Clinic of the Department of Ophthalmology and Optometry of the General Hospital of Dubrovnik patients with a diagnosis of rhegmatogenous retinal detachment in the period from 1.1.2004 to 31.12.2013 were analyzed. The study excluded patients which were not residents of Dubrovnik-Neretva County.
Dubrovnik-Neretva County is located in south Croatia, had 122 568 residents, and 1 781 km area. The county seat is Dubrovnik, and all patients with suspicion of retinal detachment are referred to the Retinal Clinic in Dubrovnik All patients had complete ophthalmologic examination, including visual acuity with and without correction (Snellen charts, decimal), biomicroscopic examination of the anterior eye segment with pupil dilatation, measuring of intraocular pressure using a Goldman aplanation tonometer, examination with a Volk Trans Equator (Volk, Mentor, OH, USA) contact lens on the Haag Streit BQ 900 biomicroscope (Haag-Streit AG, Koeniz, Switzerland) and B scan (Ultrascan Imaging system Alcon) From the Retinal Clinic archive following data was analyzed: sex, age, diagnosis year, affected eye, visual acuity on diagnosis, visual acuity after therapy, type of therapy, localization of retinal detachment, risk factors, second eye rupture, redetachment, and presence of comorbidity.
For data analysis descriptive and inferential statistics were used. Mean ± standard deviation, and percentages were used as descriptive parameters of quantitative variables, and value of less than 0.05 was considered statistically signifi cant. Differences in distributions of categorical data were evaluated by Chi-square test and comparison of means by T test. All statistical analyses were performed with the SPSS 13.0 software (SPSS Inc., Chicago, IL, USA).

Results
In this study there were 92 participants (94 eyes) involved which had rhegmatogenous retinal detachment diagnosed in a period from 1. Two patients had bilateral retinal detachment (2.12%). There were 48 females (51.1%) and 46 (48.9%) males included in the study. There was no statistically signifi cant difference in number p = 0.835 p> 0.05. The youngest patient was 24 years old and the oldest 86 years. The largest number of cases was in the older age groups. At the age 60 to 80 there were 54 patients (57, 45%). The mean age of all patients was 61.14 years.
The distribution by age group is shown in fi gure 2. In most of studies light is suggested as a precipitating factor for RRD in a damaged retina, but in our study the most cases of RRD were in spring, and we have not explanation for that.      Table 2: Visual acuity before and after therapy depending on risk factor.

Risk factor
Visual acuity per 100,000 residents, but in this study authors presented nontraumatic phakic rhegmatogenous retinal detachment [6].

Before therapy
Literature states that European countries have between 6, 9 to 18, 2 incidences of RRD on 100, 000.00 residents: Laatikainen in Helsinki [6,7,9] Törnquist et al. [8] 10.6 and Algvere [9] 14 in Sweden, Mitry [10] in Scotland 12.05, and Van de Put MA 18.2 in Netherland [11]. These studies have different inclusion criteria and analyzed time, so the comparison does not have to be valid.
Li states yearly incidence of 7.98 on 100,000 residents of Beijing China [12].
The higher incidence in women was found in a small number of studies in the pseudophakes and in the non-traumatic group [18][19][20][21][22].
In most studies the right eye is often more affected by the ratio R:L 1.09:1 and 1.36:1. [7,12,18,19], but in this study the difference was not statistically signifi cant.
The most risk factor in our study was myopia, similar as found in most studies (8,10). Other commonly mentioned risk factors are cataract surgery or eye or head trauma [7,12,15].
In this study 2.12% had bilateral RRD, less than Tomquist study 11.2% (8) and Benmerzouga 4.11% in the general population, and in high myopia patients 9.17% [23]. From the documentation it is evident that our patients with bilateral RRD did not perform regular ophthalmological control exam.
Retinal redetachment in our study is too high as 39.36% of the total number of patients. Goezinne reported a signifi cantly lower redetachment rate of 7%, but only those who developed retinal redetachment 6 months after the conventional ablation surgery were included in the study [21].
Li stated in his work that after 310 days of observation, 11 out of 105 eyes (10.4%) developed redetachment after removal of silicone oil. There was a signifi cant difference in aphakia eyes 21.1% and phakia or pseudo-phakia 4.5% [22]. We do hope that the quicker surgery will result in the better postoperative outcomes.