Influence of Relaxing Retinotomy Upon Surgical Outcomes in Proliferative Vitreoretinopathy

Abstract

Abstract: : Purpose: To determine the role of relaxing retinotomy incisions upon initial surgical success rates in the repair of recurrent retinal detachment (RD) due to proliferative vitreoretinopathy (PVR). Methods: A total of 115 eyes with recurrent RD due to PVR were included in this study. Exclusion criteria were: history of giant retinal tear, uveitis, trauma, proliferative diabetic retinopathy, and age under 18 years. 53 eyes underwent retinotomy at the time of surgery; 62 eyes were repaired without this technique. Gas (n=38) or silicone oil (n=77) was used as postoperative tamponade. Statistical analyses were performed using Fisher’s exact test. Results: The mean age of the patients was 59.5±14.9 years (range 22 to 92 years), and the mean follow–up time was 18.1±6.8 months (range 3 to 63 months). Ultimate surgical reattachment was achieved in all eyes except 5 silicone oil cases, 4 without retinotomy and 1 with retinotomy. In 18 cases requiring further surgery for repair (excluding silicone oil removal), recurrent RD developed due to reproliferation in 10 eyes and to new retinal breaks in 8 eyes (1 in the gas tamponade group; 7 in silicone oil group). Initial anatomic results for eyes with or without retinotomy are summarized in Table 1. Table 1. Anatomic results for eyes with or without retinotomy. 

* defined as retinal detachment requiring further vitrectomy surgery. The results indicated that use of retinotomy in gas tamponade eyes had no significant influence on the above anatomic outcomes. By contrast, eyes receiving silicone oil tamponade, had significantly higher rates of retinal detachment requiring reoperation when a retinotomy incision was not employed. Conclusions: When silicone oil is used as a postoperative tamponade in surgery for PVR, the use of relaxing retinotomy incisions, particularly within the inferior quadrants, may increase the initial anatomic surgical success rate.

Keywords: proliferative vitreoretinopathy • retinal detachment