Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment.

Vincenza Bonfiglio,Michele Reibaldi,Katarzyna Nowomiejska,Mario Damiano Toro,Andrea Russo,Giovanni Cillino,Elina Ortisi,Corrado Pizzo,Alessandra Pizzo,Robert Rejdak,Clara Patane,Maria Vadalà,Antonio Longo,Teresio Avitabile,Salvatore Cillino,Iacopo Macchi,Michele Rinaldi,Matteo Fallico

doi:10.3390/jcm9051556

Abstract

The treatment for rhegmatogenous retinal detachment (RRD) is surgery, including pars plana vitrectomy (PPV) and scleral buckling (SB). Despite surgical advances, degeneration of the photoreceptors and post-operative complications, such as proliferative vitreoretinopathy (PVR), often occurs as the result of inflammation, preventing complete visual recovery or causing RRD recurrence. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs and the surgery itself induces an inflammatory response. This comprehensive review focuses on the use of different formulations of corticosteroids (CCS), as an adjunctive treatment to surgery, either PPV or SB, for RRD repair. The purpose was to review the efficacy and safety of CCS in improving functional and anatomical outcomes and in preventing postoperative complications. This review is organized according to the timing of CCS administration: preoperative, intraoperative, and postoperative. The evidence reviewed supported the role of the pre-operative use of CCS in the treatment of combined RRD and choroidal detachment (CD), reducing CD height. No solid consensus exists on intraoperative and postoperative use of CCS to treat and prevent postoperative complications. However, a large randomized clinical trial including more than 200 eyes suggested that oral prednisone after surgery decreases the rate of postoperative grade B PVR.

Highlights

Rhegmatogenous retinal detachment (RRD) is a common retinal disease with an incidence of one in 10,000 people per year [1] that often causes visual field defects and moderate to severe visual impairment
After the exclusion of studies on the basis of irrelevant titles and abstracts or failure to meet inclusion criteria, 23 studies were assessed as eligible and included in our review (Figure 1)
Among the 11 studies reviewed, we identified 6 studies investigating the use of intravitreal triamcinolone (IVTA) and 3 studies assessing the use of the DEX implant in addition to surgery to treat RRD

Summary

Introduction

Rhegmatogenous retinal detachment (RRD) is a common retinal disease with an incidence of one in 10,000 people per year [1] that often causes visual field defects and moderate to severe visual impairment. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs, in particular when it is associated with choroidal detachment [5,6]. The surgeries themselves, both scleral buckle (SB) and pars plana vitrectomy (PPV), induces an inflammatory response as demonstrated by an increase of aqueous flare values, from day one up to three months post-operatively with the peak value observed at post-operative day seven [7]. The use of CCS in addition to surgery, either SB or PPV, has been introduced in the management of RRD to control inflammation, improving reattachment rates and visual recovery, and reducing the incidence of PVR [9]. Several studies have already investigated the efficacy of CCS prior, during, and after surgery for RRD repair, administered in different formulations: topical, subconjunctival, subtenon (ST), intravitreal (IVT) and systemic; there is no agreement about the most efficient formulation with the least side effects

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Conclusion