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P. Mruthyunjaya, S. Stinnett, B.W. McCuen; Relaxing Retinotomy in Proliferative Vitreoretinopathy Surgery: Long Term Results . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5488.
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Purpose: Vitreous surgery combined with membrane peeling (MP) and extended tamponade has been used to treat retinal detachments(RD) associated with proliferative vitreoretinopathy (PVR). In selected cases, residual traction or intrinsic contraction of the retina prevents reattachment with MP alone. This study explores the long–term functional and anatomic results of relaxing retinotomy (RR) performed during RD repair in eyes with severe PVR. Methods: A retrospective, noncomparative, consecutive, single surgeon case series from an academic institution was reviewed. Patients were included who underwent vitrectomy for PVR RD which required a RR and silicone oil tamponade and were followed for at least 3 months. Relationships between pre– and post–operative visual acuity and anatomic attachment were assessed using Wilcoxon signed rank and McNemar's tests. Results: Eighty–three eyes of 82 patients were identified. Median follow–up was 32 months. The most common indications for surgery were pseudophakic rhegmatogenous RD (39%), phakic rhegmatogenous RD (20%), trauma–associated RD (12%), and proliferative diabetic retinopathy (PDR) (9%). Previous unsuccessful vitrectomy without RR was attempted in 45% of eyes. Preoperative median acuity was hand motions. A total or subtotal RD with macular involvement was found in 84% of eyes. Median retinotomy size was 180 degrees with the inferior retina (4–8 o’clock) incorporated into the RR in 86% of cases. At last follow up, silicone oil had been removed in 42% of eyes. Median final acuity was 20/400, an improvement of 0.5 logMAR units (p<0.001). Visual acuity improved significantly for all diagnoses except trauma– and PDR–associated RD. Of 69 eyes starting with worse than 5/200E, 54% improved to better than 5/200E (p<0.001). Complete reattachment was achieved in 89% eyes with an overall median improvement of 0.7 logMAR units. Hypotony (16%) was the most common complication. Conclusions: Use of large relaxing retinotomy to relieve retinal traction remains an important technique in the treatment of severe PVR associated RD. In this series, RR was associated with a highly significant anatomic reattachment rate and visual acuity improvement. Increased experience may help surgeons better identify when to employ this technique.
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