Comparison of pars plana vitrectomy for retinal detachment after failed pneumatic retinopexy and primary pars plana vitrectomy

Abstract

To compare secondary pars plana vitrectomy (PPV) after failed pneumatic retinopexy (PR) (Group 1) with primary PPV (Group 2) for repair of rhegmatogenous retinal detachment (RRD), with respect to single-procedure reattachment rate and visual outcome. A consecutive series of RRD patients treated with PPV following failed PR (n=42) were compared with a selected group of RRD patients who were initially treated with PPV (n=29) with a similar location and distribution of retinal breaks. Main outcomes studied were retinal reattachment rate with single PPV in eyes treated with PPV and gas tamponade or after silicone oil removal in eyes with PPV and SO tamponade, as well as visual acuity at 1-year. The retinal reattachment rate was 90.5% and 93.1% in Group 1 and Group 2, respectively. There was no statistically significant difference in retinal reattachment between groups (P=0.69). Final anatomical reattachment rates after reoperations were 100% in each group. Visual acuity (logarithm of the minimum angle of resolution) improved from 1.95±0.84 at baseline to 0.67±0.35 in Group 1, and from 1.99±1.01 at baseline to 0.65±0.32 in Group 2. Both groups had a significant visual acuity improvement at 1-year compared to baseline (P<0.001 in each of them). Retinal reattachment rate was not associated with lens status (phakic vs pseudophakic) or intraocular tamponade (gas vs silicone oil). Visual outcomes were correlated with macular status at baseline and the number of reoperations. This study demonstrates that PPV after failed PR and primary PPV in patients with RRD caused by superiorly located retinal breaks have a similar rate of retinal reattachment along with an improved final VA. Initial success of PPV and macular status may be important predictors of final visual outcomes.