Retinotomies and retinectomies for treatment of refractory complex retinal detachment

Abstract

Objective To study the efficacy of retinotomy and retinectomy for treatment of refractory complex retinal detachment.Methods A retrospective survey was done in 50 patients (50eyes) with refractory complex retinal detachment in our hospital from January,2006 to December,2008.Patients underwent scleral buckling,lensectomy or ultrasonic fragmentation and vitrectomy with peripheral retinotomy and retinectomy,proliferation membrane peeling,underwater electric coagulation,gas-liquid exchange,perfluorocarbon liquid pressure,retinal laser photocoagulation and extraocular cryotherapy,silicone oil and peffluorocarbon liquid exchange; Observed of retinal reattachment rate,visual function and complications during different periods both intraoperation and after operation.Results (1).Intraoperative retinal reattachment rate of 50 eyes (100％); 1 week after operation 48 eyes (96％); 6-12 months (average 8.78± 1.83 months) of follow-up 45 eyes (90％); Final follow-up 24-60months (average 39.00 ± 9.96 months) 44 (88％).(2).Postoperative best corrected visual acuity (BCVA)by comparison of preoperative:1 week after operation,BCVA increased in 18 eyes (36％),10-40 centimeter Figure Counter in 22 eyes (44％),better or equal 0.01 in 5 eyes (10％),and best BCVA of 0.02; 6-12 months follow-up,BCVA increased in 23 eyes (46％),10-40centimeter Figure Counter in 25 eyes (50％),better or equal 0.01 in 7 eyes (14％),and best BCVA of 0.03; Final follow-up 24-60months,BCVA increased in 20 eyes (40％),10-40centimeter Figure Counter in 23 eyes (46％),0.01and above in 6 eyes (12％),best BCVA of 0.03.(3).Intraoperative complications included retinal self-limiting hemorrhage in 5 eyes (10％),retina with a small activity hemorrhage in 4 eyes (8％),central retinal artery occlusion in 2 eyes (4％).Complications after operation in 1 week:low intraocular pressure in 5 eyes (10％),transient high intraocular pressure in 15 eyes (30％),corneal edema in 2eyes (4％),anterior chamber bloody exudative membrane formation in 30 eyes (60％).Complications after operation in 6-12 months:low intraocular pressure and eyeball atrophy in 8 eyes (16％),persistent high intraocular pressure in 2 eyes (4％),silicone oil emulsion in 3 eyes (6％).Final follow-up complications in 24-60 months with silicone oil dependent eye 8 (16％),retinal vascular membrane or fiber membrane formation leading to proliferation retinal detachment 6 (12％).Conclusions Retinotomy and retinectomy applies to refractory complex retinal detachment that can not do or fail by conventional vitrectomy,although the complication rate is high and the recovery rate of visual function is low,But the rate of retina anatomic reattachment increasing offers hope to protect the eyeball and to salvage useful vision. Key words: Retinotomy; Retinectomy; Complex retinal detachment