Bilateral rhegmatogenous retinal detachment: frequency and clinical characteristics of surgically-treated eyes in a single academic hospital

Bilateral rhegmatogenous retinal detachment: frequency and clinical characteristics of surgically-treated eyes in a single academic hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bilateral rhegmatogenous retinal detachment: frequency and clinical characteristics of surgically-treated eyes in a single academic hospital Naoko Iizuka, Masahiro Ishida, Yoshikazu Ichikawa, Asuka Takeyama, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7873132/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To report frequency and clinical characteristics of bilateral rhegmatogenous retinal detachment (RRD) which was treated surgically in a single academic hospital. Methods Consecutive Cases of RRD which underwent vitrectomy or scleral buckling surgery between January 2019 and December 2023 at Teikyo University School of Medicine, Mizonokuchi Hospital (Kawasaki, JAPAN) were retrospectively studied.. Clinical characteristics including functional and anatomic features of RRD, presence of systemic disease, and history of eye diseases or surgery were analyzed. Characteristics of unilateral and bilateral RRD were compared. Results Among consecutive 340 patients undergoing RRD surgery, 320 patients had the surgery for one eye, and 20 patients (5.8%) had for both eyes. The mean age of unilateral cases was 53 ± 13 years with 212 males (66%) and that of bilateral was 54 ± 15 years with 17 males (85%, chi-squared test: P = 0.08). Anatomic and functional characteristics, and surgical outcomes are similar between the 2 groups. The time between occurrence of RRD of 2 eyes was very variable, 98 ± 111 months (range 16 days to 29 years). Patients with a history of cataract surgery and retinal manifestations like familiar exudative vitreoretinopathy (FEVR suspects) were more frequent in bilateral group than unilateral group (chi-square test, P = 0.006 and P < 0.0001, respectively). Conclusions Frequency of bilateral RRD is 5.8% whose intervals between RRD of two eyes range from days to decades of year. Patients with previous IOL surgery appear to be more concomitant with bilateral RRD than unilateral, which would be useful to predict bilateral occurrence of RRD. rhegmatogenous retinal detachment surgery bilateral and unilateral cataract surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Rhegmatogenous retinal detachment (RRD) occurs with an annual incidence of between 0.01–0.02% of populations [ 1 – 3 ]. Several factors are associated with increased risk of RRD, such as presence of peripheral retinal degenerations, high myopia, Caucasian or Asian ethnicity, history of RRD in fellow eyes, cataract surgery and age [ 4 ]. Bilaterality is also common in retinal diseases. Age-related macular degeneration [ 5 ], high myopia [ 6 ], and central serous chorioretinopathy [ 7 ] are likely to occur in both eyes. Because RRD occurs occasionally in both eyes and its frequency increases with age and myopic eyes, it is important to know the frequency of bilaterality of RRD in order to understand pathophysiology of RRD. Being male is reported to be associated with increased frequency of RRD [ 4 ]. It seems also beneficial for our patients of RRD to inform the risk of RRD in unaffected eyes when fellow eyes are treated for RRD. In this study, clinical characteristics of unilateral and bilateral RRD, which were surgically treated in a single academic hospital with limited number of surgeons, were compared. Because redetachment in eyes with successful RD surgery was often associated with cataract surgery [ 8 ], it is important to know the history of cataract surgery in patients with bilateral RRD. We also focus on the frequency and surgical outcomes of bilateral RRD which is compared with those of unilateral RRD, whose data are important to know current trends of RRD and its treatment in Tokyo metropolitan area. There was a well-designed large cohort study of RRD in Japan (Japan-Retinal Detachment Registry Report), whose clinical data have been collected from 3219 Japanese RRD cases from 26 qualified institutions located nationwide between February 2016 and March 2017 [ 9 ]. This huge study reported functional outcomes of RRD undergoing different surgical procedures and regional and sex differences in the treatment of RRD [ 10 , 11 ], however, in order to perform strict statistical analysis, this study (J-RD registry) collected information of the first RRD for statistical analysis in bilateral cases. Therefore the purpose and significance of our current study is to investigate to know how often we encounter bilateral RRD in a single academic hospital and what the features of bilateral RRD are compared with those of unilateral RRD. Material and methods The consecutive patients with RRD undergoing retinal detachment surgery from January 2019 to December 2023 at Teikyo University School of Medicine. University Hospital Mizonokuchi (Kawasaki, Kanagawa prefecture, JAPAN) were studied retrospectively. The study was approved by the Institutional Review Board of Teikyo University School of Medicine (No.24–029) and the study conformed to the tenets of the Declaration of Helsinki. An informed consent for the surgery was obtained from each of the patients. Patients were recruited from a single institute and analyzed, who were surgically treated as rhegmatogenous retinal detachment (RRD) unless they met exclusion criteria as follows. Eyes with macular hole retinal detachment, RRD combined with proliferative diabetic retinopathy, proliferative vitreoretinopathy which is grade C or severer, RRD or retinal break treated just as “retinal tears” with laser photocoagulation were excluded from the current study. All the patients were treated either with scleral buckling surgery without vitrectomy, vitrectomy, and vitrectomy combined with buckling as surgical modalities. Pneumatic retinopexy was not performed in our institution because the procedure was not allowed with institutional review board of our institution. Surgical procedures are routine 25-gauge vitreous surgery with SF 6 gas or silicon oil as tamponade, or scleral buckling with silicon sponge whose details have been described in our earlier publication [ 12 ]. Briefly, vitreous surgery was done with making 3 ports, creation of posterior vitreous detachment, shaving peripheral vitreous cortex, fluid-air exchange, and laser treatment for retinal breaks. Scleral buckling surgery was done with scleral identification of the points of retinal breaks using binocular ophthalmoscopy, cryopexy for retinal breaks, drainage of subretinal fluid, and placement of silicone sponge. Cataract surgery was basically done simultaneously with vitreous surgery. when lens was phakic and the patients were older than 40 years. Surgery was done with 4 experienced surgeons (M.I, Y. Ichikawa, A.T, and Y. Imamura). History of systemic diseases (hypertension, diabetes, atopic dermatitis) and eye surgeries including cataract surgery, RRD surgery, and laser-assisted in situ keratomileusis are collected using information of the descriptions of charts. Presence of anatomic features like FEVR, judged as “FEVR suspect”, are based on the phenotypes (bilateral peripheral avascular area and retinal tortuosity with or without dragged disc as described previously [ 13 , 14 ]) according to descriptions of surgical records and photographs (a representative case shown in Fig. 1 ). Because most of patients were referred for surgical intervention for RRD to our hospital and returned to local ophthalmologists after surgery, fluorescein angiography (FA) was not able to be performed for FEVR suspects. Genetic test was not performed to confirm diagnosis of FEVR. Descriptive statistics (t-test or chi-squared test) was used to see the differences between 2 groups: bilateral (group1) and unilateral RRD (group 2). P < 0.05 was considered significant. The information collected included age at time of surgery, sex, interval between diagnosis and surgery, best- corrected visual acuity (BCVA), intraocular pressure, refractive error, axial length, lens status (aphakia, phakia or pseudophakia), type of retinal tears/ holes (atrophic holes, tears, or breaks at or near the vitreous base), number of tears or holes, area of detachment (1–4 quadrants), presence of macular detachment, choroidal detachment. Decimal visual acuities were converted to LogMAR visual acuity for analysis. Information of the patients was basically collected preoperatively, 1 week, 1month, 3 months, 6 months and 1 year after surgery. Retinal attachment was defined as anatomic success of retinal detachment and eyes filled with silicon oil was not considered to be with surgical success. Results RRD surgery was performed for 340 patients (229 males (71.5%) ) whose age (mean ± SD) was 54 ± 13 years, between January 2019 and December 2023 at Teikyo University School of Medicine, University Hospital Mizonokuchi (Kawasaki, JAPAN). Among them, 20 patients (5.8%) underwent RRD surgery for both eyes. Seven patients did bilaterally only in our institution, and the other 13 did surgery for one eye here during the period and for the other eye at different institutions before. Clinical characteristics of 27 eyes of 20 patients who underwent RRD surgery for both eyes in our institution were as follows. Mean age was 54 ± 15 years (17 males and 3 females) (Table 1), and the time between occurrence of RRD of 2 eyes was 98 ± 111 months (range 16 days to 29 years), whose details are shown in Fig. 2 . This interval is longer than that of a previous report (2.6 years in a German study) [ 15 ]. This result indicated the time between RRD of 2 eyes was very variable. We encountered a case who showed RRD in the fellow eye about 2 weeks after the surgery for the other eye. (Fig. 2 – 4 ). Comparison of clinical characteristics of 2 groups (group 1: bilateral cases and group 2: unilateral cases) is shown in Table 1 with detailed information. Anatomic and functional characteristics of RD (macular-off, retinal breaks, area of RD, surgical procedures, final attachment, and BCVA) are similar between the 2 groups. Twenty-nine eyes of group 1 underwent vitreous surgery, and 2 eyes underwent scleral buckling surgery, and 320 eyes of group 2 did vitreous surgery and 55 did buckling. Anatomic success was achieved in 27 of 27 eyes of group 1 and in 318 of 320 eyes of group 2 with the 2 eyes filled with remaining silicon oil. Functional outcomes as measured with BCVA at final visits were similar between 2 groups (0.1 vs 0.07, t-test, P = 0.62). Seventeen of 20 patients of group 1 were male (85%) and 212 of 320 of group 2 were male (66%), however the difference is not statistically significant (P = 0.08). History of cataract surgery was 10 of 27 eyes in group 1 and 51 of 320 eyes in group 2 (chi-square test, P = 0.006), and the frequency of patients with FEVR suspect was 4 of 20 (20%) in group 1 and 3 of 320 (0.9%, chi-square test, P < 0.001) in group 2, indicating that cataract surgery and genetic background may have increased the susceptibility of bilateral RRD. History of hypertension, diabetes, atopic dermatitis, laser-assisted in situ keratomileusis, or eye trauma appear not to affect bilaterality of RRD (Table 1). Representative case of bilateral RRD (51-year-old male) is shown in Figs. 3 , 4 and 5 , whose interval between the occurrence of RRD of 2 eyes was 15 days. Retinal manifestations of a FEVR suspect (43-year-old male), where peripheral avascular area and breaks located at demarcation line were detected intraoperatively, was shown in Fig. 1 . Discussion RRD is relatively infrequent disease (1 or 2 in 10000 populations per year) and can occur bilaterally. [ 4 ] This study showed that the frequency of bilateral RRD undergoing RD surgery in a single academic hospital is 5.8% among all of the surgically-treated RD patients. Clinical characteristics including anatomical and functional outcomes appear similar between unilateral RRD and bilateral. In this study, FEVR suspects and history of IOL surgery were more associated with bilateral RRD cases than unilateral. The incidence of RRD after IOL surgery is approximately 10 times higher than in the general populations [ 1 ]. Therefore, IOL surgery in both eyes may have enhanced the risk of occurrence of bilateral RRD in this study. Ferrara et al reported that among 8133 eyes undergoing primary RRD repair from the Britain & Eire Association of Vitreoretinal Surgeons (BEAVRS) RRD audit database and the Euretina RRD database, 507 eyes (9.0%) had the fellow eyes with previous or concomitant RRD [ 4 ]. Our results showed 5.8% of all of the surgically-treated RD patients had bilateral RRD, and clinical characteristics of RRD in this study reflect real-world tendency of RRD in Tokyo metropolitan area. FEVR is typically characterized as a peripheral avascular area in the temporal retina, often in a V-shaped pattern with its apex pointing posteriorly. [ 13 , 14 ] FEVR has been associated with at least seven genes (LRP5, TSPAN12, NDP, FZD4, KIF11, ZNF408, and RCBTB1). [ 16 ] In our case series, FEVR suspects were judged by presence of retinal manifestations, and FA and genetic test were not performed, which resulted in lack of definite diagnosis of FEVR. Because of the high degree of symmetry of type of retinal break, number of breaks, and localization of the RRD were observed in both eyes of bilateral RRD [ 17 ], genetic factors would play a role for the occurrence of bilateral RRD. There is a large prospective cohort study by a registry design which studied clinical characteristics and surgical outcomes in Japan, which is designated as Japan-Retinal Detachment Registry Report [ 9 ]. This study has been reported with multiple volumes and very informative, however the study used the first RD for statistical analysis in bilateral cases [ 9 ], therefore our study provides additional clinical features of RRD, particularly its bilaterality, in the area. Our study has several weaknesses. The patients were recruited from a single academic hospital therefore the number of RRD patients was relatively limited. Decision of FEVR suspect was based on description of surgical records and photographs which were judged by surgeons according to anatomical features of retinal manifestations like FEVR, and FA and genetic testing would have made the diagnosis of FEVR more accurate. We are not able to know the occurrence of RRD in our RRD cases after the end of follow-up at our hospital, whose data would have made the rate of bilaterality different. The patients of unilateral RRD may have developed or may develop in future RRD in fellow eyes, which is a limitation of the current study. However, this study successfully revealed frequency and clinical characteristics of bilateral and unilateral RRD in Tokyo metropolitan area without possible biases which might be caused in multicenter studies. Cataract surgery may lower concentration of intravitreal hyaluronic acid which would enhance posterior vitreous detachment [ 14 ], which explains that pseudophakic patients are likely to have bilateral RRD. In addition, a very recent study showed that about 30% of eyes underwent cataract surgery between initial RRD repair and delayed RRD [ 8 ]. In summary, the frequency of bilateral RRD is 5.8% among all RRD undergoing RD surgery in a single academic hospital and history of IOL surgery is more associated with bilateral cases. The interval between occurrence of RRD of 2 eyes was 8.2 years which is longer than considered. Elucidation of clinical characteristics of bilateral RRD would be useful to inform our patients the risk and imaging and genetic studies would be needed to deepen our knowledge of characteristics of bilateral RRD in future. Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were mainly performed by Naoko Iizuka. The first draft of the manuscript was written by Yutaka Imamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements None. Data Availability The data that support the findings of this study are available on request from the corresponding author. References Qureshi MH, Steel DHW. Retinal detachment following cataract phacoemulsification-a review of the literature. Eye (Lond). 2020; 34:616–631. van Leeuwen R, Haarman AEG, van de Put MAJ, Klaver CCW, Los LI. Dutch Rhegmatogenous Retinal Detachment Study Group. Association of rhegmatogenous retinal detachment incidence with myopia prevalence in the Netherlands. JAMA Ophthalmol. 2021; 139:85–92. Nielsen BR, Alberti M, Bjerrum SS, la Cour M. The incidence of rhegmatogenous retinal detachment is increasing. Acta Ophthalmol. 2020; 98:603–6. Ferrara M, Al-Zubaidy M, Song A, Avery P, Laidlaw DA, Williamson TH, Yorston D, Steel DHW. BEAVRS and Euretina VR Retinal Detachment Outcomes Group. The effect of age on phenotype of primary rhegmatogenous retinal detachment. 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Surgical success rate of scleral buckling surgery and postoperative incidence of cystoid macular edema: 10 Years of experience at a single academic hospital. J Clin Med. 2022; 11:5321. DOI: 10.3390/jcm11185321 Ikeda T, Fujikado T, Tano Y, Tsujikawa K, Koizumi K, Sawa H,Yasuhara K, Maeda K, Kinoshita S. Vitrectomy for rhegmatogenous or tractional retinal detachment with familial exudative vitreoretinopathy. Ophthalmology. 1999; 106:1081–1085. Katagiri S, Yokoi T, Yoshida-Uemura T, Nishina S, Azuma N. Characteristics of retinal breaks and surgical outcomes in rhegmatogenous retinal detachment in familial exudative vitreoretinopathy. Ophthalmol Retina. 2018; 2:720–725. Radeck V, Schindler F, Helbig H, Gamulescu MA, Cvetkov Y, Barth T, Maerker D. Characteristics of bilateral retinal detachment. Ophthalmologica 2023;246:99–106. Govers BM, van Huet RAC, Roosing S, Keijser S, Los LI, den Hollander AI Klevering BJ. The genetics and disease mechanisms of rhegmatogenous retinal detachment. Prog Retin Eye Res. 2023; 97:101158. DOI: 10.1016/j.preteyeres.2022.101158 Mitry D, Charteris DG, Fleck BW, Campbell H, Singh J. The epidemiology of rhegmatogenous retinal detachment: geographical variation and clinical associations. Br J Ophthalmol 2010;94:678–684. Statements & Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. All authors contributed to the study conception and design. Material preparation, data collection and analysis were mainly performed by Naoko Iizuka. The first draft of the manuscript was written by Yutaka Imamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. 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18:52:18","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25561,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/0603973e86d616e07f647d31.png"},{"id":94134731,"identity":"fd8c64a5-6ca5-48fc-b4d8-2382c601ac62","added_by":"auto","created_at":"2025-10-22 18:44:18","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56845,"visible":true,"origin":"","legend":"","description":"","filename":"b30a7d14398c4ddf837489b167aad0ba1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/74cbb3313233c5e5275f2db9.xml"},{"id":94134742,"identity":"91972ad7-9c04-42fc-ba57-18ec01909993","added_by":"auto","created_at":"2025-10-22 18:44:18","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65392,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/36c2878aff28b04c5bdf237b.html"},{"id":94136363,"identity":"5a156a84-b000-48c4-b090-34c870961022","added_by":"auto","created_at":"2025-10-22 19:08:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4478216,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Right eye of a 43-year-old male with a history of RRD surgery for his left eye. (B) Peripheral avascular area where vitreous was firmly attached was observed during vitreous surgery. Multiple retinal breaks (one break pointed with a black arrow) were observed at the boundary of the demarcation line (white arrows) between the vascular and avascular area, suggesting the possible diagnosis of familiar exudative vitreoretinopathy.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/8fe52ec0ea08b8705acd487b.png"},{"id":94135126,"identity":"763c511c-eff4-4de6-8122-02b9e6458f74","added_by":"auto","created_at":"2025-10-22 18:52:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":178011,"visible":true,"origin":"","legend":"\u003cp\u003eA. Distribution of age at the time of first rhegmatogenous retinal detachment (RRD) in patients with bilateral RRD. 10s means age of teens (10-19 years). B. Distribution of the interval between the times of first RRD and RRD in fellow eyes. The time between occurrence of RRD of 2 eyes was 98±111 months (range: 16 days to 29 years).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/efe0ccfa2378b6c05cc026a6.png"},{"id":94135698,"identity":"a9bc070f-d3ef-4908-a37a-5be512dd92c6","added_by":"auto","created_at":"2025-10-22 19:00:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5210476,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs of both eyes in a 51-year-old male with RRD in his right eye which was treated with vitreous surgery.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/c201b0ad4bd65d17183e68d3.png"},{"id":94135129,"identity":"6f4da9d4-6eef-4dbe-9ff8-7b6014516ab9","added_by":"auto","created_at":"2025-10-22 18:52:18","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":4605659,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs of both eyes in the same patient 15 days after the surgery for the right eye. RRD appeared in his left eye.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/42425a4e8ad9e46a7277f0a9.png"},{"id":94134723,"identity":"8facc696-401f-4309-93c4-1bcbd028c893","added_by":"auto","created_at":"2025-10-22 18:44:18","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":4455388,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs of both eyes in the same patient 3 months after the surgery for the left eye. Final visual acuities were 1.0 in the right eye and 1.2 in the left.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/db32817b63519d8e7bcbbc97.png"},{"id":98431120,"identity":"a70d5d42-b0c6-40c2-9469-3e2063140b11","added_by":"auto","created_at":"2025-12-17 16:47:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":18828455,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/64842af5-1f7c-4bb9-9ef5-159e72feafc2.pdf"},{"id":94134719,"identity":"2ae8ed28-80ed-45b1-82b0-8f2f2577cff3","added_by":"auto","created_at":"2025-10-22 18:44:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31771,"visible":true,"origin":"","legend":"","description":"","filename":"TableIO.docx","url":"https://assets-eu.researchsquare.com/files/rs-7873132/v1/3f9a5c14986386906e5b3f20.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bilateral rhegmatogenous retinal detachment: frequency and clinical characteristics of surgically-treated eyes in a single academic hospital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRhegmatogenous retinal detachment (RRD) occurs with an annual incidence of between 0.01\u0026ndash;0.02% of populations [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Several factors are associated with increased risk of RRD, such as presence of peripheral retinal degenerations, high myopia, Caucasian or Asian ethnicity, history of RRD in fellow eyes, cataract surgery and age [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Bilaterality is also common in retinal diseases. Age-related macular degeneration [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], high myopia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and central serous chorioretinopathy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] are likely to occur in both eyes. Because RRD occurs occasionally in both eyes and its frequency increases with age and myopic eyes, it is important to know the frequency of bilaterality of RRD in order to understand pathophysiology of RRD. Being male is reported to be associated with increased frequency of RRD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It seems also beneficial for our patients of RRD to inform the risk of RRD in unaffected eyes when fellow eyes are treated for RRD. In this study, clinical characteristics of unilateral and bilateral RRD, which were surgically treated in a single academic hospital with limited number of surgeons, were compared. Because redetachment in eyes with successful RD surgery was often associated with cataract surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], it is important to know the history of cataract surgery in patients with bilateral RRD. We also focus on the frequency and surgical outcomes of bilateral RRD which is compared with those of unilateral RRD, whose data are important to know current trends of RRD and its treatment in Tokyo metropolitan area.\u003c/p\u003e\u003cp\u003eThere was a well-designed large cohort study of RRD in Japan (Japan-Retinal Detachment Registry Report), whose clinical data have been collected from 3219 Japanese RRD cases from 26 qualified institutions located nationwide between February 2016 and March 2017 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This huge study reported functional outcomes of RRD undergoing different surgical procedures and regional and sex differences in the treatment of RRD [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], however, in order to perform strict statistical analysis, this study (J-RD registry) collected information of the first RRD for statistical analysis in bilateral cases. Therefore the purpose and significance of our current study is to investigate to know how often we encounter bilateral RRD in a single academic hospital and what the features of bilateral RRD are compared with those of unilateral RRD.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThe consecutive patients with RRD undergoing retinal detachment surgery from January 2019 to December 2023 at Teikyo University School of Medicine. University Hospital Mizonokuchi (Kawasaki, Kanagawa prefecture, JAPAN) were studied retrospectively. The study was approved by the Institutional Review Board of Teikyo University School of Medicine (No.24\u0026ndash;029) and the study conformed to the tenets of the Declaration of Helsinki. An informed consent for the surgery was obtained from each of the patients. Patients were recruited from a single institute and analyzed, who were surgically treated as rhegmatogenous retinal detachment (RRD) unless they met exclusion criteria as follows. Eyes with macular hole retinal detachment, RRD combined with proliferative diabetic retinopathy, proliferative vitreoretinopathy which is grade C or severer, RRD or retinal break treated just as \u0026ldquo;retinal tears\u0026rdquo; with laser photocoagulation were excluded from the current study. All the patients were treated either with scleral buckling surgery without vitrectomy, vitrectomy, and vitrectomy combined with buckling as surgical modalities. Pneumatic retinopexy was not performed in our institution because the procedure was not allowed with institutional review board of our institution. Surgical procedures are routine 25-gauge vitreous surgery with SF\u003csub\u003e6\u003c/sub\u003e gas or silicon oil as tamponade, or scleral buckling with silicon sponge whose details have been described in our earlier publication [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Briefly, vitreous surgery was done with making 3 ports, creation of posterior vitreous detachment, shaving peripheral vitreous cortex, fluid-air exchange, and laser treatment for retinal breaks. Scleral buckling surgery was done with scleral identification of the points of retinal breaks using binocular ophthalmoscopy, cryopexy for retinal breaks, drainage of subretinal fluid, and placement of silicone sponge. Cataract surgery was basically done simultaneously with vitreous surgery. when lens was phakic and the patients were older than 40 years. Surgery was done with 4 experienced surgeons (M.I, Y. Ichikawa, A.T, and Y. Imamura). History of systemic diseases (hypertension, diabetes, atopic dermatitis) and eye surgeries including cataract surgery, RRD surgery, and laser-assisted in situ keratomileusis are collected using information of the descriptions of charts. Presence of anatomic features like FEVR, judged as \u0026ldquo;FEVR suspect\u0026rdquo;, are based on the phenotypes (bilateral peripheral avascular area and retinal tortuosity with or without dragged disc as described previously [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]) according to descriptions of surgical records and photographs (a representative case shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Because most of patients were referred for surgical intervention for RRD to our hospital and returned to local ophthalmologists after surgery, fluorescein angiography (FA) was not able to be performed for FEVR suspects. Genetic test was not performed to confirm diagnosis of FEVR.\u003c/p\u003e\u003cp\u003eDescriptive statistics (t-test or chi-squared test) was used to see the differences between 2 groups: bilateral (group1) and unilateral RRD (group 2). P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. The information collected included age at time of surgery, sex, interval between diagnosis and surgery, best- corrected visual acuity (BCVA), intraocular pressure, refractive error, axial length, lens status (aphakia, phakia or pseudophakia), type of retinal tears/ holes (atrophic holes, tears, or breaks at or near the vitreous base), number of tears or holes, area of detachment (1\u0026ndash;4 quadrants), presence of macular detachment, choroidal detachment. Decimal visual acuities were converted to LogMAR visual acuity for analysis. Information of the patients was basically collected preoperatively, 1 week, 1month, 3 months, 6 months and 1 year after surgery. Retinal attachment was defined as anatomic success of retinal detachment and eyes filled with silicon oil was not considered to be with surgical success.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eRRD surgery was performed for 340 patients (229 males (71.5%) ) whose age (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) was 54\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years, between January 2019 and December 2023 at Teikyo University School of Medicine, University Hospital Mizonokuchi (Kawasaki, JAPAN). Among them, 20 patients (5.8%) underwent RRD surgery for both eyes. Seven patients did bilaterally only in our institution, and the other 13 did surgery for one eye here during the period and for the other eye at different institutions before.\u003c/p\u003e\u003cp\u003eClinical characteristics of 27 eyes of 20 patients who underwent RRD surgery for both eyes in our institution were as follows. Mean age was 54\u0026thinsp;\u0026plusmn;\u0026thinsp;15 years (17 males and 3 females) (Table\u0026nbsp;1), and the time between occurrence of RRD of 2 eyes was 98\u0026thinsp;\u0026plusmn;\u0026thinsp;111 months (range 16 days to 29 years), whose details are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This interval is longer than that of a previous report (2.6 years in a German study) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This result indicated the time between RRD of 2 eyes was very variable. We encountered a case who showed RRD in the fellow eye about 2 weeks after the surgery for the other eye. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Comparison of clinical characteristics of 2 groups (group 1: bilateral cases and group 2: unilateral cases) is shown in Table\u0026nbsp;1 with detailed information.\u003c/p\u003e\u003cp\u003eAnatomic and functional characteristics of RD (macular-off, retinal breaks, area of RD, surgical procedures, final attachment, and BCVA) are similar between the 2 groups. Twenty-nine eyes of group 1 underwent vitreous surgery, and 2 eyes underwent scleral buckling surgery, and 320 eyes of group 2 did vitreous surgery and 55 did buckling. Anatomic success was achieved in 27 of 27 eyes of group 1 and in 318 of 320 eyes of group 2 with the 2 eyes filled with remaining silicon oil. Functional outcomes as measured with BCVA at final visits were similar between 2 groups (0.1 vs 0.07, t-test, P\u0026thinsp;=\u0026thinsp;0.62). Seventeen of 20 patients of group 1 were male (85%) and 212 of 320 of group 2 were male (66%), however the difference is not statistically significant (P\u0026thinsp;=\u0026thinsp;0.08). History of cataract surgery was 10 of 27 eyes in group 1 and 51 of 320 eyes in group 2 (chi-square test, P\u0026thinsp;=\u0026thinsp;0.006), and the frequency of patients with FEVR suspect was 4 of 20 (20%) in group 1 and 3 of 320 (0.9%, chi-square test, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in group 2, indicating that cataract surgery and genetic background may have increased the susceptibility of bilateral RRD. History of hypertension, diabetes, atopic dermatitis, laser-assisted in situ keratomileusis, or eye trauma appear not to affect bilaterality of RRD (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eRepresentative case of bilateral RRD (51-year-old male) is shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ,\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, whose interval between the occurrence of RRD of 2 eyes was 15 days. Retinal manifestations of a FEVR suspect (43-year-old male), where peripheral avascular area and breaks located at demarcation line were detected intraoperatively, was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRRD is relatively infrequent disease (1 or 2 in 10000 populations per year) and can occur bilaterally. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] This study showed that the frequency of bilateral RRD undergoing RD surgery in a single academic hospital is 5.8% among all of the surgically-treated RD patients. Clinical characteristics including anatomical and functional outcomes appear similar between unilateral RRD and bilateral.\u003c/p\u003e\u003cp\u003eIn this study, FEVR suspects and history of IOL surgery were more associated with bilateral RRD cases than unilateral. The incidence of RRD after IOL surgery is approximately 10 times higher than in the general populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, IOL surgery in both eyes may have enhanced the risk of occurrence of bilateral RRD in this study.\u003c/p\u003e\u003cp\u003eFerrara et al reported that among 8133 eyes undergoing primary RRD repair from the Britain \u0026amp; Eire Association of Vitreoretinal Surgeons (BEAVRS) RRD audit database and the Euretina RRD database, 507 eyes (9.0%) had the fellow eyes with previous or concomitant RRD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Our results showed 5.8% of all of the surgically-treated RD patients had bilateral RRD, and clinical characteristics of RRD in this study reflect real-world tendency of RRD in Tokyo metropolitan area.\u003c/p\u003e\u003cp\u003eFEVR is typically characterized as a peripheral avascular area in the temporal retina, often in a V-shaped pattern with its apex pointing posteriorly. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] FEVR has been associated with at least seven genes (LRP5, \u003cem\u003eTSPAN12, NDP, FZD4, KIF11, ZNF408, and RCBTB1).\u003c/em\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In our case series, FEVR suspects were judged by presence of retinal manifestations, and FA and genetic test were not performed, which resulted in lack of definite diagnosis of FEVR. Because of the high degree of symmetry of type of retinal break, number of breaks, and localization of the RRD were observed in both eyes of bilateral RRD [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], genetic factors would play a role for the occurrence of bilateral RRD.\u003c/p\u003e\u003cp\u003eThere is a large prospective cohort study by a registry design which studied clinical characteristics and surgical outcomes in Japan, which is designated as Japan-Retinal Detachment Registry Report [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This study has been reported with multiple volumes and very informative, however the study used the first RD for statistical analysis in bilateral cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], therefore our study provides additional clinical features of RRD, particularly its bilaterality, in the area.\u003c/p\u003e\u003cp\u003eOur study has several weaknesses. The patients were recruited from a single academic hospital therefore the number of RRD patients was relatively limited. Decision of FEVR suspect was based on description of surgical records and photographs which were judged by surgeons according to anatomical features of retinal manifestations like FEVR, and FA and genetic testing would have made the diagnosis of FEVR more accurate. We are not able to know the occurrence of RRD in our RRD cases after the end of follow-up at our hospital, whose data would have made the rate of bilaterality different. The patients of unilateral RRD may have developed or may develop in future RRD in fellow eyes, which is a limitation of the current study. However, this study successfully revealed frequency and clinical characteristics of bilateral and unilateral RRD in Tokyo metropolitan area without possible biases which might be caused in multicenter studies. Cataract surgery may lower concentration of intravitreal hyaluronic acid which would enhance posterior vitreous detachment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which explains that pseudophakic patients are likely to have bilateral RRD. In addition, a very recent study showed that about 30% of eyes underwent cataract surgery between initial RRD repair and delayed RRD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, the frequency of bilateral RRD is 5.8% among all RRD undergoing RD surgery in a single academic hospital and history of IOL surgery is more associated with bilateral cases. The interval between occurrence of RRD of 2 eyes was 8.2 years which is longer than considered. Elucidation of clinical characteristics of bilateral RRD would be useful to inform our patients the risk and imaging and genetic studies would be needed to deepen our knowledge of characteristics of bilateral RRD in future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were mainly performed by Naoko Iizuka. The first draft of the manuscript was written by Yutaka Imamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eQureshi MH, Steel DHW. Retinal detachment following cataract phacoemulsification-a review of the literature. Eye (Lond). 2020; 34:616\u0026ndash;631.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Leeuwen R, Haarman AEG, van de Put MAJ, Klaver CCW, Los LI. Dutch Rhegmatogenous Retinal Detachment Study Group. Association of rhegmatogenous retinal detachment incidence with myopia prevalence in the Netherlands. JAMA Ophthalmol. 2021; 139:85\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNielsen BR, Alberti M, Bjerrum SS, la Cour M. The incidence of rhegmatogenous retinal detachment is increasing. Acta Ophthalmol. 2020; 98:603\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerrara M, Al-Zubaidy M, Song A, Avery P, Laidlaw DA, Williamson TH, Yorston D, Steel DHW. BEAVRS and Euretina VR Retinal Detachment Outcomes Group. The effect of age on phenotype of primary rhegmatogenous retinal detachment. Eye (Lond). 2023; 37:1114\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZweifel SA, Spaide RF, Curcio CA, Malek G, Imamura Y. Reticular pseudodrusen are subretinal drusenoid deposits. Ophthalmology. 2010 117:303\u0026ndash;12\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFujiwara T, Imamura Y, Margolis R, Slakter JS, Spaide RF. Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes. Am J Ophthalmol. 2009; 148:445\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eImamura Y, Fujiwara T, Margolis R, Spaide RF. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina. 2009; 29:1469\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWakabayashi T, Liu CK, Momenaei B, Nahar A, Yu J, Nguyen MK, Pashaee B, Vemula S, Durrani A, Hsu J, \u003csup\u003e,\u003c/sup\u003e SJ Kuriyan AE, Yonekawa Y Delayed Retinal Detachment Study Group. Delayed-Onset Recurrent Retinal Detachment More Than One Year After Pneumatic Retinopexy, Scleral Buckle, or Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair: Incidence, Characteristics, and Outcomes Retina. 2025 May 7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IAE.0000000000004518\u003c/span\u003e\u003cspan address=\"10.1097/IAE.0000000000004518\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Online ahead of print.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSakamoto T, Kawano S, Kawasaki R, Hirakata A, Yamashita H, Yamamoto S, Ishibashi T and members of the J-RD Registry group. Japan-Retinal Detachment Registry Report I: preoperative findings in eyes with primary retinal detachment. Jpn J Ophthalmol. 2020;64:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaba T, Kawasaki R, Yamakiri K, Koto T, Nishitsuka K, Yamamoto S, Sakamoto T; Japan-Retinal Detachment Registry Group. Visual outcomes after surgery for primary rhegmatogenous retinal detachment in era of microincision vitrectomy: Japan-Retinal Detachment Registry Report IV. Br J Ophthalmol. 2021;105:227\u0026ndash;232.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFunatsu R, Terasaki H, Sakamoto T; Japan Retinal Detachment Registry study group. Regional and sex differences in retinal detachment surgery: Japan-retinal detachment registry report. Sci Rep. 2021;11:20611. DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-021-00186-w\u003c/span\u003e\u003cspan address=\"10.1038/s41598-021-00186-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWatanabe A, Ishida M, Takeyama A, Ichikawa Y, Mizushima A, Imamura Y. Surgical success rate of scleral buckling surgery and postoperative incidence of cystoid macular edema: 10 Years of experience at a single academic hospital. J Clin Med. 2022; 11:5321. DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11185321\u003c/span\u003e\u003cspan address=\"10.3390/jcm11185321\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIkeda T, Fujikado T, Tano Y, Tsujikawa K, Koizumi K, Sawa H,Yasuhara K, Maeda K, Kinoshita S. Vitrectomy for rhegmatogenous or tractional retinal detachment with familial exudative vitreoretinopathy. Ophthalmology. 1999; 106:1081\u0026ndash;1085.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKatagiri S, Yokoi T, Yoshida-Uemura T, Nishina S, Azuma N. Characteristics of retinal breaks and surgical outcomes in rhegmatogenous retinal detachment in familial exudative vitreoretinopathy. Ophthalmol Retina. 2018; 2:720\u0026ndash;725.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRadeck V, Schindler F, Helbig H, Gamulescu MA, Cvetkov Y, Barth T, Maerker D. Characteristics of bilateral retinal detachment. Ophthalmologica 2023;246:99\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGovers BM, van Huet RAC, Roosing S, Keijser S, Los LI, den Hollander AI Klevering BJ. The genetics and disease mechanisms of rhegmatogenous retinal detachment. Prog Retin Eye Res. 2023; 97:101158. DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.preteyeres.2022.101158\u003c/span\u003e\u003cspan address=\"10.1016/j.preteyeres.2022.101158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitry D, Charteris DG, Fleck BW, Campbell H, Singh J. The epidemiology of rhegmatogenous retinal detachment: geographical variation and clinical associations. Br J Ophthalmol 2010;94:678\u0026ndash;684.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStatements \u0026amp; Declarations\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were mainly performed by Naoko Iizuka. The first draft of the manuscript was written by Yutaka Imamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"rhegmatogenous retinal detachment, surgery, bilateral and unilateral, cataract surgery","lastPublishedDoi":"10.21203/rs.3.rs-7873132/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7873132/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo report frequency and clinical characteristics of bilateral rhegmatogenous retinal detachment (RRD) which was treated surgically in a single academic hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eConsecutive Cases of RRD which underwent vitrectomy or scleral buckling surgery between January 2019 and December 2023 at Teikyo University School of Medicine, Mizonokuchi Hospital (Kawasaki, JAPAN) were retrospectively studied.. Clinical characteristics including functional and anatomic features of RRD, presence of systemic disease, and history of eye diseases or surgery were analyzed. Characteristics of unilateral and bilateral RRD were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong consecutive 340 patients undergoing RRD surgery, 320 patients had the surgery for one eye, and 20 patients (5.8%) had for both eyes. The mean age of unilateral cases was 53\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years with 212 males (66%) and that of bilateral was 54\u0026thinsp;\u0026plusmn;\u0026thinsp;15 years with 17 males (85%, chi-squared test: P\u0026thinsp;=\u0026thinsp;0.08). Anatomic and functional characteristics, and surgical outcomes are similar between the 2 groups. The time between occurrence of RRD of 2 eyes was very variable, 98\u0026thinsp;\u0026plusmn;\u0026thinsp;111 months (range 16 days to 29 years). Patients with a history of cataract surgery and retinal manifestations like familiar exudative vitreoretinopathy (FEVR suspects) were more frequent in bilateral group than unilateral group (chi-square test, P\u0026thinsp;=\u0026thinsp;0.006 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, respectively).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFrequency of bilateral RRD is 5.8% whose intervals between RRD of two eyes range from days to decades of year. Patients with previous IOL surgery appear to be more concomitant with bilateral RRD than unilateral, which would be useful to predict bilateral occurrence of RRD.\u003c/p\u003e","manuscriptTitle":"Bilateral rhegmatogenous retinal detachment: frequency and clinical characteristics of surgically-treated eyes in a single academic hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 18:44:13","doi":"10.21203/rs.3.rs-7873132/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d9d7aa4-f9ca-4461-87a2-4b5f1f8377e3","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-13T11:54:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 18:44:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7873132","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7873132","identity":"rs-7873132","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}