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Hugo Quiroz-Mercado, Guillermo Salcedo, Jeffrey L Olson, Naresh Mandava, Scott C Oliver; Successful Globe Salvage In "Inoperable" Rhegmatogenous Retinal Detachment: Retrospective Study Of Ten Cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1125.
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To describe the pre-, intra-, and post-operative characteristics of ten cases of severe rhegmatogenous retinal detachment, previously considered inoperable due to a poor surgical prognosis.
A retrospective, observational and descriptive study. Patients were included if they had been deemed inoperable by another surgeon elsewhere, and were referred to our center by the primary retina specialist, or if the patient sought a second opinion. All patients underwent complete ophthalmologic examination with visual acuity (VA) testing, slit-lamp biomicroscopy, intraocular pressure measurement, and indirect ophthalmoscopy. Characteristics were divided into pre-, intra- and post-operative periods.
Ten eyes of 10 consecutive patients were included. The pre-operative characteristics included a VA range from 20/200 to no-light-perception; 6 patients had 3 previous surgeries, 2 patients had two previous surgeries and 2 patients had only been operated once previously; only two patients had a previous scleral buckle; six patients presented anterior proliferative vitreo-retinopathy (PVR); 3 cases presented sub-retinal PVR. All patients underwent a pars plana vitrectomy (PPV); in three cases a lensectomy was performed; a scleral buckle procedure was also done in three cases. In all patients a retinectomy was needed, 180 degrees in 6 cases and 360 degrees in 4 cases. Anterior base dissection was performed in 5 patients. The only tamponade used was silicone oil. Post-opeative VA ranged from 20/200 to light-perception. Vision decreased in 2 cases, and improved in 6. The retina was completely attached at the end of follow-up in 9 OF 10 patients, and the macula was attached in all cases. No eyes developed phthisis bulbi.
The description of pre-, intra-, and post-operative characteristics of eyes with severe rhegmatogenous retinal detachment are important when considering the advantages of surgery in these difficult cases. Using advanced techniques such as meticulous membrane peeling, anterior base dissection and adequately large retinectomies, globe salvage can be attained frequently in cases of complex retinal detachment.
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