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K. Johansson, M. Malmsjo, F. Ghosh; Tailored Vitrectomy and Laser Photocoagulation Without Scleral Buckling for Primary Rhegmatogenous Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4215.
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To investigate the anatomical and functional results and complications of patients operated with primary pars plana vitrectomy, without scleral buckling for all forms of rhegmatogenous retinal detachment (RRD).
A retrospective study was performed on consecutive patients treated for RRD during a three–year period by one surgeon (FG). All eyes with a RRD were included except for cases with previous vitreoretinal surgery, or trauma. During the studied period, no scleral band or buckle was used. A total of 131 eyes from 131 patients were included and were followed for 3–14 months. The surgical protocol included a total removal of vitreous in the quadrant(s) corresponding to the RD and in the inferior quadrant, while the peripheral vitreous corresponding to remaining attached retina was left. Endolaser retinopexy was used for treatment of retinal breaks, and as a peripheral scatter corresponding to the extension of the RD.
The retina was reattached in 87% of the eyes after one procedure and in 95 % after subsequent operations. The most common cause of redetachment was proliferative vitreoretinopathy. Factors significantly associated with anatomical failure were the use of retinotomy and C3F8. In the group of patients with macula detached initially, the median postoperative visual acuity (VA, Monoyer chart) was 0.4 (0.04 preop). In the group with macula attached initially, the median post operative VA was 0.7 (0.8 preop). Increased lens opacification ocurred in 68% of phakic eyes. Six patients developed ocular hypertension which was reversibel in all cases but one. Six patients developed an epiretinal membrane. In 3 cases a visual field defect was reported.
Tailored vitrectomy and laser photocoagulation is a well suited treatment for all types of RRD. The primary anatomical success rate is high and the postoperative VA is well improved in the group with macula detached initially. In the group with attached macula VA is stabilized. Cataract formation is common but other complications are rare.
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