Standardized surgical procedure in complicated retinal detachment

Abstract

Purpose Within the last ten years the surgical procedures have been refined in patients with complex retinal detachments resulting in a better anatomical outcome. The reported reattachment rates vary from 54-96 %. Limited information about the final outcome of the complete cohort of complicated retinal detachment eyes after silicone oil removal is available. Several risk factors for redetachment have been identified: the number of previously unsuccessful surgeries, an incomplete removal of the vitreous base, the absence of an encircling element and the lack of a 360° laser retinopexy. However, the additional use of relaxing retinotomies, an encircling band and lens removal were up to the surgeons discretion. Based on the conclusions of these previous studies the present study investigated the impact of a standardized treatment approach on the anatomical and visual outcome in eyes with PVR grade C2 following unsuccessful retinal detachment surgery. Methods The standardized treatment comprised of vitrectomy, placement of an encercling band, 360° laser retinopexy and silicone oil endotamponade in every eye combined with a small incision cataract surgery, if the patients were phakic. More than 50 eyes of 50 patients with failed prior scleral buckling procedure were included in this study. Results Reoperations had to be performed in 25% of the eyes. The final reattachment rate 6 months after silicone removal was 95.8%. Macular pucker was found in 12%. 70% (43 patients) achieved a visual acuity of 20/200 or better. Conclusion Standardized approach had no impact in the number of reoperation or the incidence of macular pucker. However it improves the final reattachment rate and consequently ameliorates the visual results.