Are Scleral Buckling and Postoperative Prone Positioning Required in Primary Vitrectomy for Rhegmatogenous Retinal Detachment?

Abstract

Abstract: : Purpose: Triamcinolone acetonide (TA)–assisted vitrectomy facilitates complete removal of peripheral vitreous that may maximize successful postoperative retinal attachment. We assessed whether scleral buckling and postoperative prone positioning are necessary to obtain satisfactory surgical result in TA–assited vitrectomy for rhegmatogenous retinal detachment (RD). Methods: 100 eyes of 99 consecutive patients underwent primary TA–assisted vitrectomy, concomitant with cataract surgery, for RD. The retinal tear(s) and hole(s) were treated by cryopexy and peripheral vitreous was completely eliminated. The fluid–gas exchange followed by 20% SF6 gas tamponade was performed in all eyes. No scleral buckling was conducted. The patients were followed up for 3 months without postoperative prone positioning. Results: 27 eyes (27 %) out of 100 eyes had inferior retinal tear(s) or hole(s). In 98 eyes (98%), we could treat RD by a single operation without any complications. In two eyes (2 %), we observed redetachment of retina due to the failure to uncover the retinal tear at superior and temporal retina, respectively, during the operation. The closure of the retinal tear in each case by the secondary operation led to the reattachment of retina. Conclusions: Successful retinal attachment was possible by TA–assisted vitrectomy without scleral buckling and postoperative prone positioning, even if the retinal tear(s) or hole(s) existed at the inferior region of retina. TA–assisted vitrectomy will provide the opportunity to lessen the physical burden of the patients for whom it is difficult to bear.

Keywords: retinal detachment • vitreoretinal surgery • retina