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T. Iwase, C. Iwase, K. Sugiyama; Feature and Management in Rhegmatogenous Retinal Detachment With Inferior Break . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1474.
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In rhegmatogenous retinal detachment (RRD) with inferior break, the success rate of pars plana vitrectomy (PPV) is not higher than in RRD without inferior break. Surgeons should recognize the features of RRD with inferior break before the surgical method is decided. we investigated the features of RRD with inferior retinal breaks and whether scleral buckling and prone position after surgery are required in vitrectomy for RRD with inferior break.
We identified patients with retinal break between the 4 and 8 o’clock meridians and defined these patients as having inferior break. Thirty–three consecutive patients had a detached vitreous and a RRD with inferior break. The mean number of retinal break and the association of retinal break to lattice degeneration were compared between the inferior break group and the control group which had a RRD outside inferior break and was comprised of consecutive 70 patients. The patients in inferior break group underwent primary PPV without scleral buckling and prone position after surgery. We removed not only all vitreous traction on retinal tears, but also vitreous fibers around lattice degeneration adequately. They were followed up for 6 months after surgery.
The mean number of retinal breaks in the inferior break group (2.7) was significantly higher than in the control group (1.4) (p<0.001). With respect to the association of retinal break to lattice degeneration, the inferior break group had a significantly higher incidence of the break within the lattice degeneration (24/33 eyes) compared to the control group (21/70 eyes) (p<0.001). Primary success rate in the inferior break group was 100% (33/33 eyes).
To achieve high success rate in PPV for RRD with inferior break requires a sufficient removal of the peripheral vitreous around the inferior lattice degeneration and retinal breaks, and a wider removal of vitreous because of the multiple numbers of retinal breaks. Additional procedure such as scleral buckling and prone position after surgery are not required in PPV for RRD with inferior break, when peripheral vitreous is removed adequately, including around lattice degeneration.
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