Small-Gauge Pars Plana Vitrectomy Without Prophylactic Endolaser: Rate Of Retinal Tear Or Detachment

Abstract

Purpose : The need for prophylactic endolaser (EL) retinopexy at the time of pars plana vitrectomy (PPV) in the absence of peripheral retinal pathology is controversial. Despite this procedure’s known adverse effects, its proponents suggest it prevents post-operative retinal tears (RT). Previous studies report highly variable rates of retinal detachment (RD) that range between 1% to 5.7% following PPV without EL and literature on the incidence of RT is limited. Our study assesses incidence of RT and RD in PPV without EL to gauge the importance of using this adjunctive treatment.

Methods : This single-center, retrospective chart review included 200 consecutive patients from January 1, 2011 to June 1, 2015 who underwent small gauge (23- or 25-gauge) PPV for macular hole or epiretinal membrane. In addition to incidence of RT or RD in the post-operative period, patients’ age, sex, preoperative best-corrected visual acuity (BCVA), and lens status were recorded. A post-operative RT or RD was defined as discovered within 3 months after PPV. Patients with high myopia, prior RT or RD, proliferative diabetic retinopathy, previous EL, or retained lens fragments were excluded. Patients who underwent combined phacovitrectomy underwent subgroup analysis.

Results : The average age was 72.3 years (range 53 - 93), 52% were females, and mean preoperative BCVA was 20/87 (range 20/25 - count fingers). 47% had concurrent cataract surgery; of the remaining patients, 66% were pseudophakic. 1 patient (0.5%) developed an RT after PPV without EL, which was found on post-operative day (POD) 10 in the inferonasal region of the retina. 2 patients (1%) developed RDs found on POD 6 and 21, with causative breaks located inferiorly. Rates of RT or RD between the subgroups of patients undergoing phacovitrectomy and PPV alone were not significantly different (1% vs. 0.5%, respectively, P = .492; X² test of independence).

Conclusions : RT or RD incidence after small gauge PPV without prophylactic EL was low. However, retinal breaks in our patients were in the inferior and inferonasal quadrants, typically the location of PPV cannula. There was no increase in RT or RD incidence for phacovitrectomy as compared to PPV alone. RT and RD rates are lower than previously reported, suggesting that prophylactic EL may provide limited benefit. Future studies may compare our findings with a group that underwent EL in addition to PPV.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.