Abstract
Abstract: :
Purpose: To evaluate pars plana vitrectomy (PPV) as a primary procedure for the repair of pseudophakic rhegmatogenous retinal detachment (RD). Methods: Retrospective, noncomparative, case series including 58 consecutive patients who underwent primary PPV for pseudophakic RD at Wills Eye Hospital between 2001–2003. All RD’s were repaired by a single surgeon and selected for primary vitrectomy without regard to location of detachment, number/location of break(s), refractive error, or macula status. Eyes with grade C proliferative vitreoretinopathy (PVR) at presentation were excluded. All eyes underwent standard 3–port PPV with shaving of the vitreous base under wide–field viewing and scleral depression. 360 degree laser photocoagulation was applied to the vitreous base region posterior to the ora serrata followed by gas tamponade with 20% SF6 (51 eyes) or 14% C3F8 (7 eyes). Main outcome measures included single surgery anatomic success, visual acuity, complications, and reoperation details in failures. Additional data included number/location of break(s), location of RD, and macula status. Results: The study included 58 eyes of 58 patients followed at least 3 months. The single surgery anatomic success rate was 54 of 58 (93%) eyes; 3 (5%) eyes redetached due to anterior PVR, requiring1, 2, and 3 additional surgeries, respectively, to achieve final anatomic success. One eye developed a new break and was reattached with repeat PPV. An average of 1.1 surgeries was required to achieve a 100% final reattachment rate; all 4 eyes that redetached were highly myopic (refraction –6.00 diopters or worse prior to cataract surgery). Location of retinal detachment, number of breaks, and macula status had no effect on anatomic success. Visual acuity tended to stabilize in the macula–on subgroup; visual acuity improved an average of 4.9 Snellen lines in the macula–off subgroup. Complications included 2 postoperative vitreous hemorrhages and 1 limited choroidal hemorrhage, none of which affected final visual acuity or anatomic reattachment. Conclusions: Primary PPV appears effective in the management of pseudophakic RD with regard to anatomic and visual success, especially in eyes that are not highly myopic. Complications were not significant in this limited group.
Keywords: retinal detachment • vitreoretinal surgery • visual acuity