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M. M.-S. Lai, A. J. Ruby, T. S. Hassan, K. A. Drenser, B. R. Garretson; Repair of Primary Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5762.
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To evaluate the anatomic and visual outcomes of primary rhegmatogenous retinal detachment (RRD) repairs performed with 25-gauge transconjunctival sutureless vitrectomy.
Retrospective, noncomparative case series evaluating 28 consecutive eyes of 27 patients that underwent standard 25-gauge transconjunctival sutureless vitrectomy to repair primary RRD. Eyes with prior retinal surgery, follow-up less than 1 month, proliferative vitreoretinopathy (PVR), or dense vitreous hemorrhage that precluded assessment of macular status were excluded from the study. Patient demographics, lens status, preoperative visual acuity (VA), and macular status were evaluated. Outcome measures included primary reattachment rate, single-operation anatomic success rate, final anatomic success rate, postoperative VA, and surgical complications.
13 of 28 detachments were macula-off prior to surgical repair. Total initial reattachment of the retina was achieved in 100% of eyes. Subsequent redetachment occurred in 6 of 28 eyes, and thus single-operation success rate was 79%. The final anatomic success rate was 100%. The mean time to redetachment was 65 days (range 25-179). Redetachment was not dependent on patient demographics, preoperative VA, lens status, or macular status. Development of new retinal breaks (67%) PVR (50%) were the most common etiologies for redetachment. Mean VA at the most recent follow-up improved from 20/80 preoperatively to 20/50 (p=0.031), and 60% of eyes had vision of 20/40 or better. Preoperative macular detachment was associated with worse postoperative visual but not anatomic outcome. 2 eyes (7%) developed postoperative choroidal hemorrhage that spontaneously resolved. No postoperative hypotony or endophthalmitis was observed.
In this small series of of primary RRD repaired with 25-gauge transconjunctival sutureless vitrectomy, excellent primary reattachment rate, final anatomic success rate, and postoperative visual outcomes were observed. However, subsequent redetachment due to new tears and/or PVR resulted in a single-operation success rate of 79%. Though a high rate of primary reattachment was seen with 25-gauge primary vitrectomy repair, there appeared to be a higher rate of subsequent redetachment than has been reported with 20-gauge techniques. Larger studies are necessary to demonstrate the efficacy of 25-gauge vitrectomy in the treatment of primary RRD, and to better understand the variables that affect outcomes with such techniques.
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