Abstract
Purpose To evaluate the effects of a modification of the traditional 25-gauge pars plana vitrectomy technique in the treatment of uncomplicated macula-on rhegmatogenous retinal detachment (RRD) with intermediate retinal break(s) and marked vitreous traction in the phakic eye. Methods Prospective, noncomparative, and interventional case series. All consecutive phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, with at least 1 year of postoperative follow-up, were enrolled. In all eyes, “localized 25-gauge vitrectomy” under air infusion with localized removal of the vitreous surrounding the retinal break(s), in association with laser photocoagulation and air tamponade, was performed. The primary end point was the rate of primary retinal attachment. Secondary end points were cataract progression and assessed by digital Scheimpflug lens photography (mean change of nuclear density units) and the rate of complications. Results Thirty-two phakic eyes were included in the final analysis. At 12 months, the primary outcome of anatomical success was achieved in 94% of eyes. The mean nuclear density units did not change significantly at any time point during the follow-up. After localized vitrectomy, one eye developed an epiretinal membrane, and one eye developed cystoid macular edema; no other significant complications were reported. Conclusions “Localized vitrectomy” has a high anatomical success rate in phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, without causing progression of cataract.
Highlights
Scleral buckling (SB), primary pars plana vitrectomy (PPV), and pneumoretinopexy (PR) are the surgical procedures to treat primary rhegmatogenous retinal detachment (RRD)
All consecutive phakic eyes that underwent 25-gauge PPV for primary macula-on primary RRD with intermediate break(s) and marked vitreous traction at the Ophthalmological Clinic of Catania between January 2014 and September 2016 were included. e risks and benefits of the treatment were explained to the patients, and a written consent was obtained in accordance with the Helsinki Declaration before the procedures. e Institutional Review Board/Ethics Committee approved the design of the study
Of the 46 phakic consecutive eyes with uncomplicated macula-on RRD and intermediate retinal break(s) with marked vitreous traction, 11 eyes were excluded (5 eyes did not have posterior vitreous detachment (PVD), 4 eyes had cataract more than grade 0.0–2.0, and 2 patients declined to participate), and 35 eyes addressed the inclusion criteria and were enrolled in the study
Summary
Scleral buckling (SB), primary pars plana vitrectomy (PPV), and pneumoretinopexy (PR) are the surgical procedures to treat primary rhegmatogenous retinal detachment (RRD). In the last few decades, primary PPV is the method of choice to manage RRD for several reasons including technical advances, lower postoperative inflammation, less patient discomfort, and greater familiarity of surgeons with this technique compared to the SB procedure [1,2,3]. E scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR) study [4] included primary medium-severe RRD with intermediate breaks, described as “breaks between the equator and major vessel arcades.”. In the management of RRD, the SPR study [5] suggested that the SB procedure in the phakic eyes shows a better postoperative visual acuity while the vitrectomy technique in the pseudophakic eyes shows better anatomical outcomes. SB is difficult to perform in cases involving an intermediate location of the break(s), and it is associated with many possible complications [6,7,8,9,10].
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