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J. T. Wilkinson, A. B. Richards, D. Choi, J. E. Robertson, Jr., C. J. Flaxel; Incidence of Retinal Detachment Following Fellow-Performed Primary Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3165.
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To evaluate the incidence and outcome of sclerotomy related complications and retinal detachment (RD) following primary pars plana vitrectomy (PPV) performed by vitreoretinal fellows and to identify potentially associated risk factors.
Medical records of patients who underwent standard 3-port PPV as a primary vitreoretinal surgery for a variety of indications were reviewed. All cases were performed by vitreoretinal fellows under the supervision of fellowship-trained staff vitreoretinal surgeons during the period of 2003 to 2006 at Oregon Health and Science University. Preoperative and postoperative data of 118 eyes in 114 patients were evaluated to estimate the incidence of sclerotomy related complications and RD for up to one year following surgery and any potentially associated risk factors. Patients with a pre-existing RD undergoing PPV were excluded from the study.
Intraoperative retinal tears were noted in 5 (4.2%) eyes, only 1 (0.8%) of which was associated with a sclerotomy site. The remaining 4 (3.4%) tears were associated with a trauma site. Postoperative RDs were noted in 8 (6.8%) patients. 2 (1.7%) of these were sclerotomy related, 1 (0.8%) could not be determined if sclerotomy related, and the remaining 5 (4.2%) were not sclerotomy related. 7 of 8 (87.5%) RDs occurred within approximately 2 months post surgery, and 1 of 8 (12.5%) occurred within approximately 6 months post surgery. A higher incidence of retinal detachment was found among patients undergoing PPV for macular hole, 3 of 8 (37.5%), and retained lens fragments, 2 of 8 (25%). The 3 remaining cases were associated with trauma, non-clearing vitreous hemorrhage secondary to proliferative diabetic retinopathy, and subretinal hemorrhage secondary to neovascular age-related macular degeneration.
Results of this study suggest that the incidence of sclerotomy related complications and RD following primary PPV performed by vitreoretinal fellows with fellowship trained attending supervision is low and is comparable with the incidence reported among all fellowship trained surgeons in previous studies in the literature.
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