Abstract
Purpose :
Since the surgical approach for progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) is controversial, the purpose of this study is to identify factors important for selecting the appropriate surgical intervention. We present the outcomes following surgical intervention for PSRDCR via pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB in a retrospective case series of 18 phakic eyes.
Methods :
Patient records from Jan 1, 2008-Dec 31, 2019 were reviewed. Charts with retinal detachment (RD) surgeries were identified using billing codes, and those with PSRDCR were included following manual screening. Charts with diagnoses other than degenerative retinoschisis or less than 6 months of follow-up following primary RD repair were excluded. Data regarding demographics, surgical approach, post-operative complications, and anatomic/functional outcomes were collected from patient records.
Results :
Of the 4973 charts reviewed, 36 eyes (0.7%) had retinoschisis with RD. Eighteen eyes of 17 patients met inclusion criteria. The median age was 54 years (range 18 to 74). All eyes were phakic and 10/18 presented with cataracts. 10/18 eyes had outer layer breaks (OLBs), 17/18 had inner layer breaks (ILBs), and 9/18 had a concurrent ILB and OLB. The single surgery anatomic success (SSAS) rate and final anatomical success rate were 66% (12/18) and 100% (18/18) respectively. Eyes treated with PPV/SB had the highest SSAS rate at 75% (9/12), while PPV and SB had SSAS rates of 66% (2/3) and 33% (1/3), respectively.
Conclusions :
The SSAS rate in this series is lower than for uncomplicated rhegmatogenous RD. The low SSAS rate may be caused by poor visualization of ILBs, especially with cataract, and the inability to remove peripheral vitreous leading to vitreous base contraction with resultant vitreoretinal traction. Due to low sample size, statistical conclusions regarding optimal surgical technique are not possible. However, a combination of PPV to enhance visualization of ILBs, and SB to mitigate vitreous base contraction should be considered for extensive PSRDCR. We further postulate that in eyes with concurrent cataract, combining phacoemulsification and IOL placement with RD repair may improve visualization of ILBs and allow the removal of peripheral vitreous.
This is a 2021 ARVO Annual Meeting abstract.