25-gauge 2 port minimal vitrectomy in selected rhegmatogenous retinal detachment patients

Abstract

Purpose: To evaluate the efficacy of 25-gauge 2 port minimal vitrectomy in selected cases of rhegmatogenous retinal detachment.

Methods: This prospective interventional case series study included 42 eyes of 42 patients affected by retinal detachment with superior retinal tears (not extended to more than one clock hour). All patients underwent a partial 25-gauge 2 port vitrectomy with the removal of the central and peripheral vitreous in the retinal tear area. An endodrainage throughout the retinal tear with a cryo-retinopexy around the tear and a 15% C3F8 gas tamponade were performed. All patients underwent complete ophthalmic evaluation including best corrected visual acuity at baseline and at follow up visits at month 6 and 12. Statistical analysis was performed on collected data.

Results: 37 out of 42 eyes (80.9%) achieved anatomical success, defined as complete retinal reattachment. In 5 eyes (11.9%) a reintervention was carried out: in 2 eyes (4.9%) a persistent retinal detachment was successfully treated with a pneumatic retinopexy, in 3 eyes a recurrent retinal detachment required reintervention with complete vitrectomy and gas tamponade. Postoperative mean BVCA was 0.42 LogMAR (range 1.0 - 0.0 logMAR) at 12 months. 20 out of 26 (76.9%) macula off eyes at baseline obtained a postoperative visual acuity improvement equal to or higher than 3 LogMAR lines. Postoperative complications included choroidal detachment in one eye (2.3%) and hypotony in two eyes (4.9%) due to gas leakage through sclerotomies.

Conclusions: 25-gauge 2 port minimal vitrectomy may be considered as an alternative technique in managing selected cases of uncomplicated rhegmatogenous retinal detachment with superior retina tears and a vitreoretinal traction judged as not amenable for scleral buckling.

Keywords: 697 retinal detachment • 762 vitreoretinal surgery • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials