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John Campo, Luke Campo, Rachel Tandias, Peng Sun, Jorge G Arroyo; Comparison of combined vitrectomy and retinectomy with and without endoscopy for rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4255.
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Endoscopy is a useful tool in ophthalmic surgery. Although it is most commonly used for treatment of refractory glaucoma by endoscopic cyclophotocoagulation, endoscopic visualization of the peripheral retina and ciliary body is also a valuable tool in vitreoretinal surgery. This study evaluates the outcomes of combined pars plana vitrectomy (PPV) and retinectomy with and without endoscopic vitreoretinal visualization for rhegmatogenous retinal detachment (RRD) with severe proliferative vitreoretinopathy (PVR).
This case-controlled, retrospective series of 41 eyes compared the outcomes of endoscopy-assisted PPV/relaxing retinectomy (n=13) versus unassisted PPV/retinectomy (n=25) performed between 2004 and 2017 for RRD with PVR of grade C-3 or higher. Exclusion criteria included proliferative diabetic retinopathy, tractional retinal detachment, and open globe trauma. Primary outcomes were complete retinal reattachment for a minimum of 3 months, final visual acuity, incidence of postoperative complications, and surgical duration.
Final anatomical success was achieved in all 41 patients. No significant differences were found between the endoscopy-assisted group and the unassisted group in primary retinal reattachment, incidence of postoperative hypotony, final visual acuity, overall change in visual acuity, and intraoperative use of perfluoro-N-octane (PFO). Mean duration of surgery was 84.6 minutes for the endoscopy group and 55.0 minutes for the unassisted group (p<0.001). An endolaser was used in 8 of 14 cases in the endoscopy group (57.1%) and in all 27 cases in the unassisted group (p<0.001). Endoscopic visualization allowed for ciliary body membrane peeling in 3 cases and was utilized for various procedures, including anterior vitreous base dissection, anterior retinectomy trimming, endoscopic laser photocoagulation, peripheral iridectomy, intracapsular cataract extraction, and PFO exchange.
Technological advancements have improved the capabilities of the endoscope in bypassing anterior segment opacities and the iris to visualize anterior structures. While use of the endoscope increases surgical duration, endoscopic vitreoretinal visualization of the pars plana and ciliary body can aid in therapeutic and preventative maneuvers and limit the use of additional intraoperative supplies.
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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