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Vikram J. Setlur, Caeser K. Luo, Jason Hsu; 23-Gauge Pars Plana Vitrectomy for Primary Repair of Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6136.
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To describe outcomes for primary repair of rhegmatogenous retinal detachment (RRD) using 23-gauge pars plana vitrectomy (PPV)
A retrospective review was performed analyzing 79 eyes of 78 patients with RRD repaired using 23-gauge PPV, endolaser, and intraocular gas tamponade. Minimum follow-up was 3 months. Patients with prior vitrectomy, grade C PVR or worse, silicone oil tamponade, or concomitant scleral buckling were excluded.
Primary anatomical success was achieved in 66 out of 79 eyes (83.5%) during a mean follow-up of 9 months. Final anatomical success was achieved in all 85 eyes (100%). The cause of redetachment was new retinal tears in 6 eyes (7.6%) and proliferative vitreoretinopathy in 7 eyes (8.9%). Time to repair of the initial RRD ranged from 0-181 days, with a median of 3 days. Macula-on RRD was present in 36 eyes (45.6%). Visual acuity improved from LogMAR 0.43 (Snellen acuity 20/50) to 0.29 (20/40) and from 2.00 (counting fingers) to 0.68 (20/100) for macula-on and macula-off cases, respectively. Post-operative complications included epiretinal membrane in 10 cases, elevated intraocular pressure in 14 cases, and a vitreous hemorrhage in 1 case which spontaneously cleared. No cases of hypotony, choroidal detachment, or endophthalmitis were seen. Thirty-eight eyes (51.4%) had multiple retinal breaks. Sixteen eyes (20.2%) had inferior detachments. Two out of 13 failed cases (15.4%) versus 14 out of 66 successes (21.2%) had inferior detachments. Perfluorocarbon liquids (PFCL) were used intraoperatively in 52 eyes (65.8%) overall, with 11 out of 13 failures (84.6%) having PFCL versus 41 of 66 successes (62.1%). Posterior drainage retinotomies were done in 7 eyes (8.9%), but none were in eyes that went on to redetach. Shaving of the vitreous base using scleral depression for 360 degrees was done in 30 cases (38.0%) overall. Four out of 13 (30.8%) failed cases versus 26 out of 66 (39.4%) successful cases employed this technique.
23-gauge PPV for initial repair of RRD achieved good primary reattachment rates, with excellent final outcomes and minimal post-operative complications.
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