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M Okuyama, Y Kondo, T Hanemoto, H Ideta; An Analysis of Failure in the Primary Vitrectomy for Rhegmatogenous Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2002;43(13):642.
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Purpose: To analyze the cause of failure in the primary vitrectomy for rhegmtogenous retinal detachment, and to suggest way to improve the success rate. Methods: In 86 eyes of 86 consecutive patients, 53 males, 33 females, treated by standard pars plana vitrectomy for rhegmatogenous retinal detachment between April 1998 and August 2001, detachment recurred in 13 cases. Age distribution was 38 ∼ 80 years old with mean of 57.5 years old. Follow-up period ranged from 3 months to 3 years. The cause of recurrence was judged by analysis of fundus diagrams before and after operation. Results: Recurrence rate was 15.3%. We found four cause of failure. (1) Re-proliferation of the residual vitreous in 5 eyes, (2) Insufficient coagulation both around the break (causing reopening of the original tear) and also around the equatorial degeneration (causing a new break formation) in 4 eyes, (3) «New» breaks in the area of atypical equatorial degeneration that were overlooked in 2 eyes, and (4) Breaks at the sclerotomy site in 2 eyes. Conclusion: To improve the success rate it is important to remove all of the vitreous including the peripheral vitreous and the lens to prevent proliferation of vitreoretinopathty. Sufficient coagulation of both the tear and the equatorial degeneration is important. Atypical equatorial degenerations, which are often overlooked, must be carefully detected and treated. Also the surgeon must take care not to cause iatrogenic breaks at the sclerotomy site.
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