Abstract
There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.
Highlights
Retinal detachment (RD) is a condition defined as separation of the neurosensory retina from the underlying retinal pigment epithelium
We report the outcomes of Rhegmatogenous retinal detachment (RRD) repair at a large tertiary academic center following dynamic examination of the far periphery with scleral depression and active flow through the vitreous cutter
Exclusion criteria for the study included any of the following: (1) a history of previous pars plana vitrectomy (PPV), scleral buckle (SB), or combination for RRD, (2) SB surgery alone for RRD, (3) PPV ± SB for RRD performed by vitreoretinal surgeons not affiliated with Massachusetts Eye and Ear (MEE), (4) insufficient follow-up, (5) proliferative vitreoretinopathy (PVR) grade C or more, (6) RD associated with proliferative diabetic retinopathy, open globe injury, infectious retinitis, and retinoschisis
Summary
Retinal detachment (RD) is a condition defined as separation of the neurosensory retina from the underlying retinal pigment epithelium. Rhegmatogenous retinal detachment (RRD) is the most common type of RD and is characterized by a break in the neurosensory retina with seepage of vitreous fluid into the subretinal space. There are currently several primary interventions employed for repair of RRDs: pneumatic retinopexy (PnR), scleral buckle (SB), and pars. Primary retinal detachment repair with extensive scleral-depressed vitrectomy
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