Evidence-based medicine regarding the prevention of retinal detachment.

PURPOSE: To assess the quality of information in the literature regarding the prevention of retinal detachment in an effort to establish appropriate practice guidelines.

METHODS: A panel of vitreoretinal experts performed a literature review of all publications in the English language for articles about prevention of retinal detachment. These article were then used to prepare recommendations for patient care in an American Academy of Ophthalmology "Preferred Practice Pattern" (PPP). Each recommendation was rated according to its importance in the care process and the strength of evidence supporting the given recommendation.

RESULTS: Most recommendations were given a rating of "A" (most important to patient care). Only a single publication was graded as Level I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as Level II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of Level I and Level II studies in the literature, Level III (consensus of expert opinion) was the basis for most recommendations in the PPP.

CONCLUSION: The current literature regarding prevention of retinal detachment does not provide sufficient information to strongly support prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.