Abstract
BackgroundRecurrent retinal detachment (RD) is still a widespread event despite the therapeutic options available. Proliferative vitreoretinopoathy (PVR) is one of the main causes of redetachment. Little is known about the use of endoscopy-assisted vitrectomy (E-PPV) in complex recurrent RD with PVR. The purpose of this study was to identify the potential advantages of E-PPV in complex RD with PVR compared with pars plana vitrectomy (PPV) alone.MethodsSingle-center, retrospective, observational, descriptive study. The medical records of 293 patients were reviewed. Patients who underwent PPV for complex rhegmatogenous RD and associated PVR between 2009 and 2017 were included. Patients with diabetic tractional RD, trauma, uveitis or detachment postendophthalmitis were excluded. After 2013, an endoscopic visualization system was used in a nonrandomized fashion at the surgeon’s discretion. Outcome measures (reattachment rate, number of surgeries, lens status, PVR stage, intraocular pressure, phthisis rate) were compared between the E-PPV and PPV-only groups with independent samples t-tests (continuous variables) and Fisher’s exact test (categorical variables), as well as time-adjusted analyses. Postoperative time to retinal redetachment was assessed with Kaplan–Meier survival analysis.ResultsOne hundred one eyes from 100 patients met the inclusion criteria. The mean participant age was 63.3 years old (95% CI 60.4–66.1 years), without a significant difference between groups. E-PPV was performed in 36.6% (n = 37) of eyes, and 63.4% (n = 64) underwent PPV only. The mean follow-up was significantly longer in the PPV-only group (31.9 vs. 21.1 months; p = 0.021). Upon adjustment for follow-up duration, the mean number of surgeries was significantly lower in the PPV-only group (2.6 vs. 4.3 number of surgeries; p < 0.001) than in the E-PPV group. A significantly higher risk for redetachment was observed in the PPV-only group (HR [95% CI] 4.1 [1.4–11.8]) than in the E-PPV group (p = 0.037). The evolution to phthisis was 7% (n = 4) in the PPV-only group and 2.7% (n = 1) in the E-PPV group (p > 0.05).ConclusionsCompared to PPV alone, endoscopy-assisted vitrectomy seems to be advantageous in achieving better reattachment rates in complex RD with advanced PVR. Endoscopic visualization allows a thorough examination and extensive anterior PVR and vitreous base dissection.
Highlights
Recurrent retinal detachment (RD) is still a widespread event despite the therapeutic options available
The study included 101 eyes from 100 patients who underwent pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) associated with Proliferative vitreoretinopoathy (PVR)
PPV pars plana vitrectomy, BCVA best corrected visual acuity, endoscopy-assisted pars plana vitrectomy (E-PPV) endoscopyassisted PPV, IOP intraocular pressure, Intraocular lens (IOL) intraocular lens, RD retinal detachment, PVR proliferative vitreoretinopathy, SO silicone oil a Proportions based on the total number of eyes included b Lens status was missing for nine eyes in the PPV only group and one eye in the endoscopy-assisted PPV group
Summary
Recurrent retinal detachment (RD) is still a widespread event despite the therapeutic options available. Little is known about the use of endoscopy-assisted vitrectomy (E-PPV) in complex recurrent RD with PVR. Recurrent rhegmatogenous retinal detachment (RRD) after surgical repair remains a relatively widespread event despite the therapeutic options currently available. Proliferative vitreoretinopoathy (PVR) is one of the main causes of redetachment and occurs in 8–10% of patients undergoing primary repair [1,2,3,4]. Little is known in the literature about the addition of endoscopy when performing a vitrectomy in recurrent retinal detachment, especially in complex detachments with PVR [7,8,9,10,11,12]. There is still a need to improve surgical outcomes in complex cases, and endoscopy-assisted vitrectomy could facilitate and address anterior pathology differently in these patients
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