Abstract
Purpose: :
To determine the outcome of vitrectomy and peripheral retinectomy without scleral buckling in treating patients with retinal detachments and severe proliferative vitreoretinopathy (PVR).
Methods: :
Retrospective medical record review of 10 consecutive patients with retinal detachment and PVR grade C-2 or greater. All patients were managed with vitrectomy and retinectomy without scleral buckling. Exclusion criteria included previous scleral buckling procedures, penetrating trauma, endophthalmitis, and age less than 20 years. Primary outcome was anatomic success, which is defined as reattachment of the macula. Secondary outcomes included visual acuity, number of vitreoretinal operations performed, and post-operative complications.
Results: :
Of the 10 patients reviewed, the mean age was 56 years (range: 47-79 years). Six patients had a history of prior eye surgeries, including cataract extraction (3 patients), corneal transplant (1), previous vitrectomy (4), and laser barricade (1). Three patients had concomitant choroidal detachments while nine patients had macula-involving detachments at initial presentation. Five patients had grade C-2 PVR, two had grade C-3, and three had grade D. Average time of follow-up was 6.4 +/- 4.3 months (range: 1-13 months), and an average of 1.5 +/- 0.53 procedures (range: 1-3) were required during follow-up to achieve anatomic success in 100% of cases (nine retinas were completely attached while one patient had stable persistent inferior subretinal fluid without macular involvement). Five patients required more than one operation. At the last follow-up, five patients experienced improved vision while three remained stable and two had decreased vision. Overall visual acuity improved from logMAR 1.72 +/-0.89 (Snellen equivalent 20/1038) to logMAR 1.43 +/- 0.76 (Snellen equivalent 20/538). Silicone oil was used for tamponade in eight patients and concomitant lensectomy was performed in four patients. There were no intraoperative or post-operative complications other than cataract formation and retinal re-detachment.
Conclusions: :
Vitrectomy and peripheral retinectomy without scleral buckling is effective in achieving anatomic success in patients with retinal detachments and severe PVR. Visual acuity was improved or maintained in the majority of patients.
Keywords: proliferative vitreoretinopathy • retinal detachment