Systematic Primary Vitrectomy Without Scleral Buckling for Pseudophakic Retinal Detachment

Abstract

Purpose: : To assess the functional and anatomical outcome of systematic primary vitrectomy without scleral buckling for pseudophakic rhegmatogenous retinal detachment (PRRD) and to compare our results to the literature.

Methods: : We retrospectively reviewed the charts of all pseudophakic patients hospitalized for rhegmatogenous retinal detachment in our two teaching hospitals. All pseudophakic patients referred for RRD were treated by primary vitrectomy without scleral buckling in case of PVR<C. The primary endpoint was the reattachment rate with a single procedure.

Results: : We reviewed 133 patient charts. The mean age was 66.6 ± 11.6. The duration of retinal detachment was 17 ± 36 days. The status of vitreoretinal proliferation (PVR) was as follows: no PVR in 61 cases (46%), PVR grade A in 20 cases (15%), PVR grade B in 52 (39%). Retinal reattachment with a single surgery was achieved in 78% in no PVR and PVR–A group, 71% in PVR–B group. The average follow up was 4 months. Retinal reattachment was achieved in 76% with a single surgery, in 94% after two surgeries and in 99% after three surgeries. These rates significantly increased (p<0.05) to 81% with a single surgery and 96% after two surgeries if the procedure was performed by a senior surgeon. The mean and median preoperative visual acuity was 1.5 and 1.7 logMAR (count fingers at 2 meters and count finger at 1 meter) respectively and increased to 0.76 and 0.3 logMAR (20/200 and 20/40) after the surgical procedure(s). The pre and post operative visual acuity were statistically correlated (p<0.05). The status of the macula was significantly correlated (p<0.05) with both anatomical and functional results. The location of the retinal tear(s) did not influence the results.

Conclusions: : Systematic primary vitrectomy without scleral buckling is an effective procedure for treating pseudophakic retinal detachment. Considering the significant difference in success rate between fellow and senior surgeons there is probably a learning curve for this surgery.

Keywords: retinal detachment