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Ravi Singh, Douglas Covert, Dennis Han; Risk of intraoperative retinal tears and recurrent rhegmatogenous retinal detachment in eyes with previous retinal detachment undergoing pars plana vitrectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2856.
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Pars plana vitrectomy (PPV) is associated with risk of intraoperative retinal tears (RT) and post-operative rhegmatogenous retinal detachment (RRD). In eyes with previous RRD repair, the risks of these events are not well documented. In the present study we evaluated eyes with previous RRD repair undergoing PPV for macular epiretinal membranes (ERM) or macular holes (MH), and compared them to eyes without prior RRD. We also assessed the effect of the previous surgical interventions on this risk.
An IRB approved, retrospective review was performed on a consecutive series of eyes undergoing PPV for MH or macular ERM from January 1, 2003, through December 31, 2009. From these, cases that had undergone prior RRD repair were selected for this study. The variables studied included patient demographics, interventions at the initial RRD repair, and microsurgical approach.
466 eyes underwent PPV for MH or ERM, of which 40 eyes had a prior history of RRD repair and were selected for analysis. Mean follow-up was 77 weeks (range 10 to 254). Intraoperative RT was observed in 1 of 23 eyes (4.3%) undergoing non-cannulated PPV, while none were noted in 17 eyes with cannulated sclerotomies. Overall rate of intraoperative RT was 2.5%. Postoperative recurrent RRD occurred in 3 eyes (7.5%). Recurrent RRD was noted in 1 of 29 eyes (3.4%) that had a prior scleral buckle (SB) with PPV compared to 2 of 10 eyes (20%) that had their prior RRD repaired with PPV without a SB (p=0.16, Fishers exact test). Recurrent RRDs were caused by new retinal tears within 1 clock hour of a surgical sclerotomy site in 2 cases while a 3rd case detached from vitreous traction from a previous sclerotomy site. The rates of intraoperative RT and postvitrectomy RRD in eyes with previous RRD repair were not significantly different from those for eyes without prior RRD [12.7% (54/426 eyes, p=0.07) and 4.9% (21/426 eyes, p=0.48), respectively].
Eyes with prior RRD repair do not appear to be at significantly different risk of intraoperative retinal tears and postvitrectomy RRD compared to eyes without a prior history of RRD. There were trends toward (1) a lower risk of intraoperative retinal tears in eyes with previous RRD repair compared to those without prior RRD and, (2) a lower risk of recurrent RRD if a prior SB procedure had been performed.
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