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Wu Liu, Bin Mo, Yajie Yu; Non-Buckled Vitrectomy For Retinal Detachment With Inferior Break With Or Without Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6157.
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To study whether inferior break-related retinal detachment (IBRD) with or without proliferative vitreoretinopathy (PVR), which is usually a challenge to retinal surgeons due to the insufficient support of the inferior retinal by the intraocular tamponade, could be treated with vitrectomy without scleral buckling.
A retrospective, consecutive, case series study was conducted. Inclusion criteria were patients with IBRD which were not suitable for external scleral buckling surgery. Exclusion criteria were recurrent retinal detachment, giant retinal tears, proliferative diabetic retinopathy, trauma, retinal vascular diseases, and congenital disorders. Surgical procedure was standard pars plana vitrectomy without scleral buckling. Minimal follow-up was 3 months.
Seventy-eight eyes of 78 patients were included and were divided into two groups: group A (PVR <C1, No.= 32 eyes) and group B (PVR≥C1, No.= 46 eyes). All (100%) patients were successfully reattached with an average follow-up of 10.7 months. Reattachment rate with one operation was 83.3% in general, and was similar between group A and B (87.5% vs 80.4%, p=0.542), but eyes in group B needed more combined cataract removal (32.5% vs 6.3%, p=0.006), retinotomy (43.5% vs 3.1%, p=0.000), and silicone oil tamponade (56.5% vs 12.5%, p=0.000) respectively. Eyes needed repeat operation were 4 in group A and 9 in group B, and the causes of the primary failure in each group were postoperative PVR in 1 eye and 8 eyes (25.0% vs 88.9%, p=0.052), and reopen of the breaks in 3 eyes and 1 eye (75.0% vs 11.1%, p=0.052), respectively. Preoperative choroidal detachment occurred in 4/13 eyes which needed repeat operation and 4/65 eyes which succeeded with single operation (6.1% vs 30.1%, p=0.023).
Vitrectomy without scleral buckling is a reasonable choice for IBRD with or without PVR. Retinotomy and silicone oil tamponade are more needed in treating the eyes with PVR. Postoperative PVR is the main cause of failure for eyes with PVR, while reopen of the break is for eye without PVR. Choroidal detachment may be a preoperative risk factor of repeat operation.
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