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Retinal detachment surgery in district general hospitals: an audit of changing practice

Despite advances in the techniques of vitreoretinal surgery, rhegmatogenous retinal detachment (RRD) continues to pose a serious threat to vision. In the past, general ophthalmologists in the United Kingdom undertook most RRD surgery, with only the more “complex” cases being referred to retinal specialists. The recent trend towards subspecialisation has led to increasing numbers of primary RRD being managed by vitreoretinal surgeons in tertiary referral centres.1

We conducted an audit to determine the current success rate of primary RRD surgery in our subregion (south west subregion, SWSR). SWSR consists of the catchments of four district general hospitals (DGH) in Devon and Somerset (population 1.2 million). A previous subregional audit in 1991 showed that all consultant ophthalmologists undertook primary RRD repair, achieving a success rate of 71% with one operation.2 Since then, retinal subspecialisation has meant that all RRDs are managed by three retinal specialists (CJ, PS, RG) in their individual DGHs, providing a subregional surgical retinal service. An informal cross cover arrangement exists between the three DGHs, with the result that patients are very rarely referred out of the subregion.

Case notes of all patients who underwent surgery for primary RRD from January to December 1999 were retrospectively reviewed. Case ascertainment was achieved by reviewing theatre logbooks and identifying all vitreoretinal procedures that took place during 1999. A single investigator (RL) collected details of …