Purchase this article with an account.
Tedi Begaj, Anna Marmalidou, Thanos D Papakostas, J. Daniel Diaz, Leo A. Kim, David M Wu, John B Miller; Higher Single Surgery Anatomic Success Rates in Retinal Detachment Repair with Meticulous Vitreous Removal. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6571.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Pars plana vitrectomy (PPV) and scleral buckle (SB), used alone or in combination (SB-PPV), are the current primary surgical procedures employed for repair of rhegmatogenous retinal detachment (RRD). Herein, we present a modern update with higher surgical anatomic success rates than previously reported.
An IRB-approved retrospective review was conducted of 190 surgical eyes of 181 patients treated for primary RRD by three vitreoretinal surgeons (LAK, JBM, DAW) at a tertiary academic medical center from May 2016 to January 2018. Inclusion criteria for the study were eyes with (1) RRD, (2) primary PPV ± SB for RRD, (3) PVR grade B or less, and (4) a minimum of 3 months of post-PPV follow-up.
Most RRD occurred in males (136 [71.6%] eyes), affected the left eye (103 [54.2%]), and were phakic (121 [63.7%]). The majority of patients (144 [75.8%] eyes) reported a duration of symptoms less than 14 days. PPV alone was performed in 161 eyes (84.7%) with a combined SB-PPV being used in only 29 eyes (15.3%); endolaser was used in all (100%) cases. Drainage of subretinal fluid was achieved either through a preexisting retinal break (151 [79.5%] eyes), drainage retinotomy (33 [17.4%]) or perfluorocarbon (PFO) (6 [3.1%]). At time of repair, the macula was detached in 118 eyes (62.1%) and attached in 72 (37.9%). 118 eyes (62.1%) had retinal detachments involving the inferior hemisphere. Few eyes (25 [13.2%]) had grade A or B proliferative vitreoretinopathy. The time from presentation to vitrectomy was 2.7 days with a standard deviation of 3.6 days. The single surgery anatomic success was 188 eyes (98.9%) at 3 months. 102 (53.7%) eyes have at least one year of follow-up, with only one additional eye requiring supplemental laser throughout follow-up.
We report a higher single surgery anatomic success rate in primary RD repair than previously described. Despite most patients presenting with phakic lens status and retinal detachments involving the inferior hemisphere, only a small number of SB-PPVs were required for successful repair. In most cases, subretinal fluid drainage was achieved through the pre-existing retinal breaks, with PFO only used in a few cases. Meticulous removal of the vitreous, careful inspection of the far periphery with scleral depression, and treatment of all pathology can lead to nearly complete single surgery successful RD repair.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
This PDF is available to Subscribers Only