Parsplana vitrectomy alone versus parsplana vitrectomy combined with phacoemulsification for the treatment of rhegmatogenous retinal detachment: a randomized study

Paolo Mora,Arturo Carta,Stefania Favilla,Stefano Gandolfi,Salvatore A Tedesco,Lucia Benatti,Giacomo Calzetti,Giulia Berselli

doi:10.1186/s12886-021-01954-y

Abstract

BackgroundTo compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD).MethodsSubjects aged 48–65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group).ResultsIn this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003).ConclusionsIn a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months.Trial registrationISRCTN15940019. Date registered: 15/01/2021 (retrospectively registered).

Highlights

To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD)
Scleral buckling surgery still plays a role in the management of some types of RRD, in recent years there has been a trend toward parsplana vitrectomy (PPV) as the primary procedure, maybe because young surgeons are familiar with this latter technique [5]
There are disadvantages of PCV: a) there is a risk of postoperative refractive errors, especially in macula-off cases; b) iatrogenic anisometropia is frequent in myopic subjects; and c) it can lead to the removal of a largely healthy organ in cases of no/ mild cataract with residual accommodative function

Summary

Introduction

To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD). There are disadvantages of PCV: a) there is a risk of postoperative refractive errors, especially in macula-off cases; b) iatrogenic anisometropia is frequent in myopic subjects; and c) it can lead to the removal of a largely healthy organ in cases of no/ mild cataract with residual accommodative function. These latter issues can be avoided by performing a lens-sparing procedure (i.e. PPV-only)

Methods

Results

Conclusion