Pars Plana Vitrectomy For Rhegmatogenous Retinal Detachment Research Articles

Selective internal limiting membrane peeling for prevention of secondary epiretinal membrane after vitrectomy for rhegmatogenous retinal detachment.

We introduce selective internal limiting membrane (ILM) peeling, a guideline procedure to determine whether to remove the ILM during vitrectomy for rhegmatogenous retinal detachment (RRD). Retrospective case series METHODS: Patients who underwent pars plana vitrectomy for RRD and were followed up for 12 months or longer were included. When vitreous cortex remnants (VCRs) were detected with triamcinolone acetonide, the ILM was removed; otherwise, the ILM was preserved ("selective ILM peeling"). The factors associated with the presence of VCRs and incidence of secondary epiretinal membrane (ERM) were analyzed. VCRs were detected in 87 of 133 eyes (65.4%) in which the ILM was removed. Younger age, better preoperative visual acuity, and vitreous hemorrhage were negatively correlated with the presence of VCRs.No ERM occurred in the eyes after ILM peeling. Among the eyes with ILM preservation, subclinical ERM was noticed in 4 eyes (8.7%), and 1 eye (2.1%) required additional surgery owing to ERM. ERM occurred more commonly in eyes with the ILM preserved (P = .004). However, no differences in the rate of additional surgeries were found between the 2 groups. Selective ILM peeling offers an alternative option to reduce the burden of ILM peeling or additional surgery.

Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated with Epiretinal Membrane Formation.

Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Conjunctival Pigmentation Following Pars Plana Vitrectomy (PPV) for Rhegmatogenous Retinal Detachment: Risk Factors and Outcomes.

To investigate the incidence and the risk factors for conjunctival pigmentation at the sclerotomy sites following valved and non-valved cannula pars plana vitrectomy (PPV) performed by different surgical techniques. This is a prospective observational study which included 70 eyes of 70 patients who underwent PPV for rhegmatogenous retinal detachment with follow-up visits at 1, 3, 6, 12, and 24 months. Twenty-eight eyes were operated using 25G non-valved cannulas (Group A), 22 eyes using 25G non-valved cannulas (Group B), and 20 eyes using 25G valved cannulas (Group C). The evaluated clinical parameters include the surgical technique, the patients' age, the number of retinal tears, the tamponade agent, the presence of residual sub-retinal fluid (SRF), and the duration of postoperative posturing. Group A was associated with significant conjunctival pigmentation at up to 6 months after PPV. Sulfur hexafluoride (SF6) gas tamponade was associated with less conjunctival pigmentation at 3 months follow-up visit [odds ratio, OR 0.09 (95% confidence interval, CI 0.01; 0.67)], whereas the presence of residual SRF was a significant risk factor for postoperative pigmentation at 1-year follow-up visit [OR 5.89 (95% CI 1.84; 23.12)]. The area of measured pigmentation was also positively correlated to the number of retinal tears at all follow-up visits over 2 years. Six patients presented with conjunctival pigmentation at 2 years follow-up visit. New vitrectomy techniques with valved cannulas prevent the postoperative appearance of conjunctival pigmentation. The number of retinal tears, the presence of SRF, and the use of long-standing tamponade agents were the most significant predisposing factors. The post-vitrectomy conjunctival pigmentation gradually reduces over time.

Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis.

Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = - 0.58, 95% CI = - 1.16 to 0.00) and post-op (SMD = - 0.45, 95% CI = - 0.60 to - 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = - 0.15 to 1.13). The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.

Outcomes of pars plana vitrectomy for rhegmatogenous retinal detachment at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa

Background: Pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment is performed as a standard of care in central hospitals in South Africa. Clinical outcomes of such a procedure need to be reported on regularly. Aim: The aim of this study was to describe the visual acuity and anatomical outcomes of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment at a central academic hospital in Johannesburg, South Africa. Setting: Pars plana vitrectomy surgery for rhegmatogenous retinal detachment in a central hospital in South Africa. Methods: Retrospective case series of patients who had PPV for rhegmatogenous retinal detachment at Charlotte Maxeke Johannesburg Academic Hospital during the 5-year period from 01 January 2010 to 31 December 2014. Results: Ninety-nine patients with rhegmatogenous detachment, comprising 62% men and 38% women, were included in the study. The mean age (± standard deviation) was 48 (±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37% and 21% of all causes, respectively. Sixty-three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty-three eyes (84%) obtained vision improvement or stabilisation and retinal attachment. Forty eyes (40%) had visual acuity improvement, and 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% ( n = 92) of eyes, including those that needed a repeat surgery. Conclusion: This study found that the majority of patients whose files were reviewed benefited from surgical intervention for rhegmatogenous retinal detachment in terms of stabilisation or improvement of vision.

Macular holes following vitrectomy for rhegmatogenous retinal detachment: epiretinal proliferation and spontaneous closure of macular holes.

To describe the characteristics and management of full-thickness macular holes (MHs) that develop after pars plana vitrectomy for rhegmatogenous retinal detachment (RD). Retrospective, interventional, consecutive case series. Patients who developed secondary full-thickness MHs after prior pars plana vitrectomy for RD over a 6-year period were included. The main outcome measures included optical coherence tomography (OCT) findings and the clinical course of full-thickness MHs. A total of 11 eyes of 11 consecutive patients were included in the study. The mean age of the patients was 58.8years (range, 47-70years). The median time between RD repair and MH diagnosis was 36months (range, 1month-11years). The fovea was attached to 10 eyes (91%) at the time of RD repair. OCT demonstrated epiretinal proliferation (EP) at the hole margin in 10 eyes (91%). MH spontaneously closed in 7 eyes (63%) but reopened in 5 eyes. A total of 7 eyes (63%) required a vitrectomy to repair the MHs. All MHs were closed at the last follow-up visit. Full-thickness MHs after pars plana vitrectomy for RD have features that are distinct from that of typical idiopathic MH. The presence of EPs is common, and MHs are prone to spontaneous closure and reopening. These findings suggest that EP may be associated with spontaneous hole closure and that long-term follow-up is necessary even if the MHs close spontaneously.

Predictive Factors for Long-Term Postoperative Visual Outcome in Patients with Macula-Off Rhegmatogenous Retinal Detachment Treated with Vitrectomy

Purpose: The purpose of this prospective study was to evaluate potential predictive factors of long-term postoperative outcomes in patients with macula-off rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV). Methods: Participants in this study were 86 patients diagnosed with macula-off RRD, who underwent PPV. Demographic characteristics and preoperative characteristics of RRD were recorded, while best corrected visual acuity (BCVA) was measured preoperatively and at specific postoperative time points (6 weeks and 6, 12, and 24 months). In addition, spectral domain-optical coherence tomography (SD-OCT) characteristics at postoperative week 6 were assessed as potential factors affecting the long-term postoperative visual outcome 24 months after PPV for RRD. Results: Increasing age, duration of RD of more than 1 week, presence of proliferative vitreoretinopathy, increasing central retinal thickness, ellipsoid zone disruption, and external limiting membrane disruption were significantly associated with a worse BVCA. BCVA was not associated with gender, lens status, the location of breaks, the gas tamponade agent used in PPV, the presence of subretinal fluid, and intraretinal fluid. Conclusions: It is important to determine predictive factors for visual outcomes in order to inform patients about their prognosis and help in the decision-making process for patient management.

Optical coherence tomography study of macular structural changes in silicone oil-filled eyes

Introduction Silicone oil (SO) has been used in complex cases of retinal detachment with proliferative vitreoretinopathy (PVR), giant retinal tear, and traumatic cases. This study aimed to assess macular structural changes in SO filled eyes after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment with PVR. Patients and methods This is a prospective interventional study that was conducted on 60 SO-filled eyes after successful PPV for rhegmatogenous retinal detachment with grade C PVR; SO was left in all eyes for a duration of 3 months. Thorough ophthalmic evaluation in Ophthalmology Department, Tanta University, Egypt was performed including best corrected visual acuity (BCVA), fundus examination, and anterior segment examination. Optical coherence tomography was done for all patients at presentation to assess the macular area. Results Epiretinal membrane (ERM) was detected in 14 (23.3%) eyes, cystoid macular edema (CME) in 21 (35%) eyes, photoreceptor disruption in 21 (35%) eyes, macular hole in one (1.7%) eye, and foveal thinning in 18 (30%) eyes. The BCVA was positively correlated with the presence of ERM, CME, and photoreceptor disruption and the results were statistically significant with ERM and photoreceptor nonintegrity with P values of 0.049 and 0.001 respectively. In addition, there is no significant correlation between changes in central retinal thickness and BCVA. Conclusion Visual loss after successful PPV in SO filled eyes can occur due to macular changes like CME, ERM, photoreceptor disruption, foveal thinning, and macular hole.

Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial

AimTo study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsIn a...

Efficacy of intravitreal dexamethasone implant for the treatment of macular oedema after pars plana vitrectomy for rhegmatogenous retinal detachment: long-term outcomes

Purpose: To investigate the efficacy and safety of intravitreal dexamethasone implant as initial and only treatment for macular oedema after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).Methods: This study included 14 patients, who were diagnosed with macular oedema after PPV for RRD and who were treated with intravitreal dexamethasone implant. Patients were examined at the time of macular oedema diagnosis (baseline) and 1, 6 and 12 months after treatment, using best corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT).Results: The mean BCVA at baseline was 0.72 ± 0.29 logMAR and improved significantly to 0.37 ± 0.21, 0.42 ± 0.19 and 0.35 ± 0.22 logMAR at month 1, 6 and 12 after treatment with dexamethasone implant. The mean central retinal thickness (CRT) was 623 ± 142 μm at baseline and decreased significantly to 339 ± 163 μm, 428 ± 131 μm and 356 ± 147 μm at month 1, 6 and 12 after treatment. Total resolution of macular oedema was observed in 10 out of 14 patients (71.4%) at month 12. Ellipsoid zone was intact in 71.4% of patients at the end of the follow-up, while 71.4% of patients received only one implant until the end of the 12-month follow-up. No adverse events were observed.Conclusions: Intravitreal dexamethasone implant was found to be effective and safe as initial treatment for macular oedema after PPV for RRD.

Risk Factors, Onset, and Progression of Epiretinal Membrane after 25-Gauge Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

To investigate the risk factors, onset timing, and progression of epiretinal membrane (ERM) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Retrospective, comparative case series. The study included 322 eyes of 322 patients who underwent primary PPV for RRD from January 2014 through December2016. Patients underwent OCT before and 1, 3, 6, and 12 months after surgery. Patients showing hyperreflective lines above the inner retinal surface and deformation of the foveal pit were defined as ERM cases. Those with loss of the foveal pit were defined as advanced ERM cases. A multivariate logistic regression model was used to evaluate the risk factors of postoperative ERM. The onset timing of ERM and progression to advanced ERM after PPV for RRD were also investigated based on the OCT findings. Risk factors, onset timing, and progression of ERM after PPV for RRD. In the multivariate analysis, the incidence of postoperative ERM was significantly higher in eyes with preoperative vitreous hemorrhage (VH; P= 0.011) and without internal limiting membrane (ILM) peeling (P < 0.001). Among the patients who underwent ILM peeling, none demonstrated postoperative ERM. Postoperative ERM was observed in 39 of the 322 eyes (12.1%) within 1 year after surgery; in 30 of these eyes (76.9%), ERM occurred within 3 months after surgery. Advanced ERM was observed in 12 eyes (12/39 eyes [30.8%]). Among these, 9 eyes (9/12 eyes [75%]) showed progression within 3 months after surgery. Preoperative VH can increase the occurrence of postoperative ERM. In most patients with ERM, the occurrence and progression were detected relatively early after surgery; therefore, in high-risk patients, careful follow-up is encouraged until 3 months after surgery.

The Influence of Silicone Oil on the Ganglion Cell Complex After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment.

Pars plana vitrectomy (PPV) and silicone oil endotamponade have been used as a treatment in rhegmatogenous retinal detachment (RRD). Improvement in the modality of spectral-domain optical coherence tomography (SD-OCT) allows for the assessment of ganglion cell layer-inner plexiform layer (GCL-IPL) in the macular region. Information about the GCL-IPL status may be a response to the question as to why the visual recovery after PPV with silicone oil tamponade is incomplete. The aim of the study was to evaluate the impact of silicone oil on GCL-IPL and compare it with other endotamponade types such as Sulfur hexafluoride gas (SF6), Perfluoropropane gas (C3F8) used during PPV performed due to RRD. The study involved 57 eyes after PPV and 57 healthy, control eyes of patients with primary RRD who had undergone successful PPV. The patients were divided into three subgroups depending on the endotamponade type, and were tracked with complete ophthalmological examination during a period of 6 months. PPV with internal tamponade silicone oil, 24% SF6 or 14% C3F8 was performed. The medical records were reviewed and compared between the groups. SD-OCT analysis detected a significant reduction of average GCL-IPL thickness and reduction of GCLIPL parameter in almost all examined sectors in the group with silicone oil endotamponade during all follow-up visits (P<0.05). The study showed a significant vision deterioration in the silicone oil group in comparison with the SF6 group on all follow-up visits (P<0.05). This is the first in vivo SD-OCT study describing the toxic effect of silicone oil endotamponade on GCL-IPL complex after PPV for RRD. The study confirmed that the GCL-IPL complex value can be a predictive factor for assessing the final visual acuity. SD-OCT should be recommended as a clinical standard in the followup treatment of patients after PPV for RRD, especially with the use of silicone oil endotamponade. Plain Language Summary: The aim of the study was to examine the impact of silicone oil on the ganglion cell complex. The ganglion cell is a neuron type located in the retina and takes part in transmitting visual information from the retina to the brain. Silicone oil is a substance used during eye surgery called pars plana vitrectomy. This tamponade type acts to hold the retina in a proper position. However, during the retinal detachment, which is the separation of the retina from the layer underneath, a reduction of neurons is observed. We decided to use a new technology device called SD-OCT to determine the thickness of the ganglion cell complex. We compared the impact of silicone oil with other tamponade types. We found that silicone oil causes a reduction in the ganglion cell complex. Moreover, we observed vision deterioration in eyes treated with a silicone oil tamponade. The research describes the toxic effect of silicone oil on ganglion cells. Ganglion cell values may be used to determine visual improvement or deterioration after eye surgery with silicone oil tamponade. SD-OCT should be a clinical standard in monitoring patients with silicone oil tamponade.

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives.

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

Characteristics of patients with spontaneous dislocation of in-the-bag intraocular lens after pars plana vitrectomy.

To determine the characteristics of eyes with late in-the-bag dislocation of an intraocular lens (IOL) after pars plana vitrectomy (PPV). Fourteen eyes of 14 patients with a dislocated IOL after PPV were studied retrospectively. The data collected from the medical charts included the age, sex, history of eye diseases, axial length, and interval from PPV to time of IOL dislocation. The surgical procedures used during the PPV were also recorded. Seven eyes had undergone PPV for rhegmatogenous retinal detachment; 6 eyes, for proliferative diabetic retinopathy; and 1 eye, for retinal vein occlusion. The average interval between the PPV and the diagnosis of the dislocated IOL was 6.2years (range 2.3-10.1years). In all eyes, the peripheral vitreous was thoroughly removed with scleral depression during the PPV. The IOL dislocation was most likely caused by damage to the zonular fibers by the peripheral vitrectomy with scleral depression.

MACULAR HOLE AFTER PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT.

To report the clinical features, possible associations and treatment outcomes of patients with macular hole after pars plana vitrectomy (PPV) (single or multiple) for rhegmatogenous retinal detachment (RD). Retrospective consecutive case series from July 2009 to July 2014. In the 15 study patients, the average time from RD surgery to macular hole diagnosis was 119 days (range: 41-398 months). Possible associations include epiretinal membrane (73%, 11/15 patients), macula-off RD (60%, 9/15 patients), recurrent RD (47%, 7/15 patients), and high myopia (56%, 5/9 patients). Single surgery was successful in hole closure in 8/15 patients (Group A) while 7/15 patients underwent multiple surgeries (Group B). Macular hole closure was achieved in 7/8 (87.5%) patients in Group A compared to 4/7 (57.1%) patients in Group B. Improvement of at least two lines of Snellen's visual acuity was achieved in 4/8 (50.0%) and 4/7 (57.1%) patients in Group A and B, respectively. In patients with macular hole formation after pars plana vitrectomy for RD, possible associations were epiretinal membrane, macula-off RD, recurrent RD, and high myopia. Even when macular hole closure was achieved, limited visual improvement occurred.

Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery

ObjectiveThis study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases. DesignRetrospective series in a tertiary care centre. ParticipantsOne hundred and twenty consecutive patients. MethodsThe medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed. ResultsThe single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point. ConclusionsConsequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.

SUPPLEMENTAL SCLERAL BUCKLE IN VITRECTOMY FOR THE REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENT: A Systematic Review of Literature and Meta-Analysis.

To evaluate the effect of supplemental scleral buckle (SB) in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. MEDLINE, EMBASE, and CENTRAL were searched to identify studies comparing PPV with supplemental SB (PPV + SB) to PPV alone for the repair of rhegmatogenous retinal detachment. The outcome measures were primary and final reattachment rates, and postoperative complications. Odds ratio with 95% confidence interval in random effects for the comparison of outcomes between PPV + SB and PPV alone was calculated. Ten studies consisting of 1,704 patients were included. Meta-analysis showed that the overall primary reattachment rate was significantly higher in PPV + SB than PPV alone (odds ratio, 1.70; 95% confidence interval, 1.21-2.39; P = 0.002). The final reattachment rate was equally high in both groups. Postoperative development of epiretinal membrane was more frequent in PPV + SB than in PPV alone (odds ratio, 1.89; 95% confidence interval, 1.30-2.76; P = 0.001), whereas no significant difference in postoperative development of macular edema, proliferative vitreoretinopathy, or elevation of intraocular pressure was found. Supplemental SB increases the primary reattachment rate in PPV for rhegmatogenous retinal detachment, although final reattachment rate was equally high with or without SB.

MACULAR HOLE AFTER VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT

To report a series of full-thickness macular holes (MH) that developed after pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). A retrospective review of the demographic and medical data, including optical coherence tomography studies of 6 patients (7 eyes) who underwent pars plana vitrectomy for RRD and subsequently developed MH. There were 4 women and 2 men with a mean age of 60 ± 10 years (range, 50-79 years). The mean interval between RRD repair and MH formation was 20 ± 18 months (range, 1-48 years). Five eyes underwent surgery to repair the MHs, four of which were closed at the last follow-up. Two eyes were not operated, one because of unfavorable prognosis, and in the other, which presented with an epiretinal membrane before the development of the MH, the hole closed spontaneously. In all operated cases, the inner limiting membrane was peeled during MH surgery. The mean logarithm of the minimal angle of resolution was 0.73, 0.53, 0.77, and 0.57 at RRD presentation, after surgical repair of RRD and before MH diagnosis, at MH presentation, and at last follow-up, respectively. The study subjects accounted for 1.1% of our 609 patients who underwent pars plana vitrectomy for primary RRD during the study period. Macular hole may develop after pars plana vitrectomy for RRD, and these cases can be surgically repaired. The pathogenesis of the formation of these holes remains unclear.

Endoscopy-Guided Subretinal Fluid Drainage in Vitrectomy for Retinal Detachment

Purpose: To study the usefulness of endoscopy-guided subretinal fluid drainage in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Participants/Methods: A prospective non-comparative study of a small number of RRD cases. The study involved examining 10 eyes of 10 patients with RRD that received PPV. Two eyes had hazy corneas, which hindered the observation by surgical microscopy. Fluid-gas exchange was performed and then subretinal fluid was drained through a primary retinal break guided by an endoscope. No drainage retinotomy was made. Each clinical feature was studied and the surgical outcome and complications were evaluated. Results: All eyes had retinal reattachment by a single operation. No serious complication related to surgery was experienced. Conclusions: Endoscopy-guided subretinal fluid drainage is the safe and effective procedure in PPV for RRD.

Intravitreal triamcinolone staining observation of residual undetached cortical vitreous after posterior vitreous detachment

To study the pattern of residual undetached cortical vitreous (RCV) after posterior vitreous detachment (PVD) in eyes with rhegmatogenous retinal detachment (RRD) and to examine the relationship between RCV and the development of epiretinal membrane (ERM). A prospective study was conducted in 33 consecutive patients with clinically evident PVD who underwent pars plana vitrectomy for RRD. During vitrectomy, triamcinolone acetonide (0.2 cm(3), 10 mg/cm(3)) was applied to stain the RCV. The pattern of the staining were recorded. The formation of postoperative ERM was correlated with the staining pattern of RCV. Each case was followed for at least 6 months. In all, 23 of the 33 patients had RCV of variable size, with a single stain patch observed in 13 patients and multiple patches in seven patients. Large circumferential areas of staining at the mid-periphery were noted in three patients. A total of 10 cases had staining over the fovea and five patients had staining over the disc. ERM developed in seven patients during follow-up. None corresponded to RCV. RCV is common in eyes with PVD and RRD. The macula and disc area are the most frequent locations for these vitreous islands. The relationship between RCV and ERM remains to be investigated.