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Vikram Setlur, Jennifer Lim; Outcomes of 25-Gauge Vitrectomy with Relaxing Retinectomy for Retinal Detachment with Severe Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2840.
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To analyze the efficacy of relaxing retinectomies using 25-gauge instrumentation for repair of severe proliferative vitreoretinopathy retinal detachments.
We performed a retrospective case review of all vitreoretinal operations performed by a single surgeon from January 2007 through October 2012 to identify eyes that underwent pars plana vitrectomy with relaxing retinectomy for repair of retinal detachment with advanced proliferative vitreoretinopathy (PVR) fibrous proliferation. Patient demographics, visual acuity, and anatomic outcomes were recorded from the medical record. Only patients with a minimum of follow up of 3 months were included.
Seventeen eyes of 17 patients met the above criteria. The etiology of the fibrous proliferation was primary rhegmatogenous retinal detachment in 8 patients, trauma in 3 patients, infection in 2 patients, proliferative diabetic retinopathy in 3 patients, and sarcoid uveitis in 1 patient. Final anatomical success was achieved in 94.1% (16/17) of patients. Silicone oil was used for tamponade in 16 out of 17 patients, and one patient received perfluoropropane (C3F8) gas tamponade. The average retinectomy encompassed 5.3 clock hours. Nine patients were successfully reattached after one procedure. Eight patients re-detached after their initial retinectomy surgery. Of these, seven patients were re-attached with an average of 2.0 additional surgeries (including vitrectomy for silicone oil removal). One remained detached at his last follow-up visit. Visual acuity was maintained or improved in 82.4% (14/17) of patients. Average logarithm of the minimum angle of resolution (logMAR) visual acuity improved from 2.2 prior to surgery to 1.8 after surgery (p = 0.2237). Complications included epithelial downgrowth requiring 5-fluorouracil injection (1 patient with penetrating trauma), hypotony (3 patients), epiretinal membrane requiring repeat vitrectomy (2 patients), and no light perception vision (2 patients).
25-gauge vitrectomy with relaxing retinectomy is an effective procedure for retinal detachments complicated by severe fibrous proliferation. The high rates of anatomic success and visual preservation suggest surgical intervention may be indicated in eyes that would otherwise be deemed inoperable.
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