Outcomes of relaxing retinectomy for recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy

Abstract

Purpose : Proliferative vitreoretinopathy (PVR) occurs in 5-10% of retinal detachment (RD) surgeries and is the most common cause of unsuccessful RD repair. The purpose of this study is to compare the anatomical and functional outcomes of modern pars plana vitrectomy (PPV) combined with retinectomy for recurrent rhegmatogenous retinal detachment (RRD) complicated by PVR with the results of the Silicone Study Report 5.

Methods : This retrospective review was conducted with data from a single physician surgeon at Beth Israel Deaconess Medical Center. The medical records of 97 patients who underwent pars plana vitrectomy with relaxing retinectomy for retinal detachment with PVR between January 2006 and August 2016 were identified. Exclusion criteria eliminated patients with proliferative diabetic retinopathy, tractional retinal detachments, and open globe trauma, leaving a total of 50 participants (n=50 eyes) with RRD and PVR of grade C or more. All participants were initially treated with three-port PPV combined with relaxing retinectomy, barrier endolaser photocoagulation, and silicone oil tamponade (n=42) or gas tamponade with SF6 (n=6) or C3F8 (n=2). The primary outcome measures were complete retinal reattachment for a minimum of 3 months and final visual acuity.

Results : Final anatomical success was achieved in all 50 patients. Successful reattachment was observed after one surgery in 37 of 50 eyes (74%). Twelve of the 13 re-detachments were successfully reattached after one reoperation. One case required a third surgery to achieve complete reattachment. Three patients developed hypotony (6%). A significant difference between pre- and postoperative best corrected visual acuity (BCVA) was defined as a change by at least 2 Snellen lines. Of the 43 patients for whom BCVA was documented, visual acuity improved in 28 patients (65.1%), remained the same in 9 patients (20.9%), and worsened in 6 patients (14.0%).

Conclusions : In 1993, the Silicone Study Report 5 reported a retinal reattachment rate of 62% at 6 months for retinotomy in eyes previously vitrectomized for RRD with PVR. Advancements in modern vitreoretinal surgery have allowed for higher rates of favorable anatomic and visual outcomes of retinectomy. The high rates of reattachment and visual acuity improvement in this case series suggest that PPV with retinectomy is an effective surgical treatment for RRD associated with PVR.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.