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Rahul Komati, Nathan Farley, Daniel Brill, Amit Sangave, Nitin Kumar, Uday Ravindra Desai; Use of a Drainage Retinotomy in Rhegmatogenous Retinal Detachment Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4245. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
During retinal detachment surgery, a drainage retinotomy facilitates subretinal fluid removal from the posterior pole when a retinal tear provides insufficient drainage. Use of this technique is surgeon-dependent due to the inherent localized retinal damage and concern for complications. This review examines visual outcomes and post-operative complications for retinal detachments repaired with the aid of a drainage retinotomy.
A retrospective chart review was performed for all rhegmatogenous retinal detachment (RRD) repairs at our academic institution from 2013 to 2016. We examined primary RRDs repaired with a standard surgical technique: 23-gauge pars plana vitrectomy with a drainage retinotomy, endoscopic laser photocoagulation, and perfluoropropane (C3F8) gas tamponade. Patients were divided into three groups based on macula status: macula-off; macula partially-off (fovea-on), and macula-on retinal detachments. Data was collected on patient demographics, pre-existing ocular conditions, location of detachment, location and number of breaks, pre/post-operative visual acuity, and post-operative complications. Exclusion criteria included diabetic retinopathy, previous retinal detachment, or previous retinal surgery in the affected eye.
A total of 167 eyes met the criteria, including 95 macula-off, 25 macula partially-off, and 47 macula-on RRDs. Final LogMAR visual acuity was 0.54 ± 0.54 for macula-off; 0.13 ± 0.18 for partially-off; and 0.10 ± 0.14 for macula-on at an average follow-up of 13.5 months after surgery. Twenty-one patients (12.6%) had a re-detachment during their follow-up period. Forty-four patients (26.3%) developed post-operative epiretinal membrane, with six patients (3.5%) requiring epiretinal membrane removal. Two patients (1.2%) developed intraoperative choroidal effusion, and one patient (0.6%) had a post-operative choroidal detachment.
Our results for RRDs repaired with the aid of a drainage retinotomy demonstrate similar outcomes to previously published data on RRDs repaired without a drainage retinotomy. A drainage retinotomy can facilitate subretinal fluid removal and retinal reattachment without increasing complication rates. Future studies should be conducted to evaluate for significant visual field defects from the retinotomy site.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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