Primary Primary Pars Plana Vitrectomy Research Articles

360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes

BackgroundTo determine patient and surgical factors associated with the use of 360-degree laser retinopexy during primary pars plana vitrectomy (PPV) ± scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes.MethodsPatients who underwent PPV ± SB for repair of non-complex RRD at a single centre were included in this retrospective study. The primary outcome was single surgery anatomical success (SSAS). Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. Multiple logistic regression and multivariate regression was used.ResultsThe study included 192 cases, of which 130 received 360-degree laser. Worse preoperative logMAR visual acuity (P = 0.009), male sex (P = 0.060), higher PVR grades, supplemental SB (P = 0.0468) and silicone oil/C3F8 tamponade (P < 0.0001) were associated with 360-degree laser use. No significant associations between 360-degree laser and SSAS (P = 0.079), final logMAR visual acuity (P = 0.0623), ERM development (P = 0.8208), postoperative CMO (P = 0.5946), tonic pupil (P > 0.9999) or corneal epithelial defects (P = N/A) were found.Conclusions360-degree laser retinopexy during primary PPV ± SB for RRD was associated with more complex cases and more extensive operations. Even when accounting for this, there was no difference in surgical outcomes or complication rates.

Re-Vitrectomy versus Combined Re-Vitrectomy with Scleral Buckling for Pediatric Recurrent Retinal Detachment.

PurposeTo compare re-vitrectomy versus combined re-vitrectomy with scleral buckling (SB) for pediatric recurrent rhegmatogenous retinal detachment (RRD) following failed primary pars plana vitrectomy (PPV).MethodsThis was a retrospective, comparative case series of pediatric patients (under 18 years) who underwent secondary RRD procedures after failed primary PPV. Patients were divided into the re-vitrectomy and the combined re-vitrectomy with SB groups. The primary outcome was the anatomical success rate for each procedure. The secondary outcomes were changes in best-corrected visual acuity (BCVA) and postoperative complications.ResultsIn the re-vitrectomy group (30 eyes), the final anatomical success rate was 83.3% (25/30) after a mean follow-up of 21.7 + 6.9 months. The final anatomical success rate in the combined re-vitrectomy/SB group (23 eyes) was 73.9% (17/23) after a mean follow-up of 26.5 + 7.7 months. There was no statistically significant difference in the final anatomical success rate (P = 0.41) and the mean change in BCVA (P = 0.37) between the two groups. Even though not statistically significant, the combined re-vitrectomy/SB group had a lower incidence of postoperative complications (P = 0.25).ConclusionRe-vitrectomy alone provides similar anatomical and functional outcomes to combined re-vitrectomy/SB for pediatric recurrent RRD after failed primary PPV.

Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment.

To compare the outcomes of phakic and pseudophakic uncomplicated rhegmatogenous retinal detachment (RRD) treated with primary pars plana vitrectomy (PPV) and short-term silicone oil (SO) tamponade. A retrospective chart review of 201 eyes (185 patients) with uncomplicated RRD treated with primary 23-gauge PPV and short-term SO tamponade. Anatomical success was defined as a reattached retina for at least 6months after SO removal. The analysis consisted of 111 phakic eyes and 90 pseudophakic eyes. The mean duration of SO tamponade in phakic eyes was 8.5±1.9 and in pseudophakic eyes was 8.3±1.9weeks [corrected] (P=0.39). The primary reattachment rate was 93% in the phakic group and 98% in the pseudophakic group (P=0.19). The mean Snellen VA equivalent at the final visit was 20/30 in both groups. Final VA≥20/40 was achieved in 81% of phakic and 86% of pseudophakic eyes (P=0.69). Postoperative complications included cataract in the phakic group (100%), transient elevation of intraocular pressure (IOP) (29%), epiretinal membrane (8%), proliferative vitreoretinopathy (7%), cystoid macular edema (3%), secondary macular hole (2%), persistent elevation of IOP (1.5%), and persistent hypotony (1%). The success rates and functional outcomes of primary 23-gauge PPV with short-term SO tamponade did not differ significantly between the two groups, suggesting that lens status is not the single most important factor influencing the final results. The use of short-term SO was not associated with keratopathy, visual loss without any apparent reason and high rates of chronic elevation of IOP or redetachment following SO removal.

SUBFOVEAL CHOROIDAL THICKNESS CHANGE AFTER PARS PLANA VITRECTOMY IN RECENT ONSET RHEGMATOGENOUS RETINAL DETACHMENT.

To evaluate changes in subfoveal choroidal thickness (SCT) after recent onset rhegmatogenous retinal detachment (RRD) and primary pars plana vitrectomy (PPV) using spectral-domain optical coherence tomography (SD-OCT). This retrospective study included 22 eyes of 22 patients who had primary PPV for the management of recent onset RRD. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central foveal thickness (CFT), and subfoveal choroidal thickness (SCT) were measured before and 1 week, 1 month, and 3 months after the surgery. The changes in measurements were compared between operated and fellow eyes. The preoperative mean SCT of eyes with RRD was 350.2 ± 47.8 μm and of fellow eyes was 258.9 ± 46.7 μm, respectively. The postoperative mean SCT of operated eyes at 1 week, 1 month, and 3 months were 265.1 ± 45.1, 260.9 ± 46.6 and 261.1 ± 46.7 μm and of fellow eyes 256.9 ± 45.8, 257 ± 46.1 and 256.8 ± 46.6 μm, respectively. A statistically significant decrease in SCT (P < 0.001), an increase in IOP (P < 0.001), and an improvement in BCVA (P < 0.001) were observed in eyes with RRD 3 months after the surgery (Friedman test). The mean preoperative SCT of eyes with RRD was found to be greater than that of fellow eyes without any ocular surgery or disease. The increased mean SCT showed a tendency to decrease after PPV. This may be related to increased uveoscleral outflow and intraocular inflammation after RRD, and it may be concluded that vitrectomy does not affect choroidal thickness.

Clinical outcomes of primary vitrectomy in pseudophakic retinal detachment

PURPOSE. To evaluate the efficacy of primary pars plana vitrectomy (PPV) for rhematogenous retinal detachment (RD) in pseudophakic eyes. MATERIALS AND METHODS. The medical records of 63 patients who had undergone PPV after phacoemulsification were reviewed retrospectively. The mean follow-up period was 10 months. Statistical analysis evaluated functional and anatomical results as well as general (diabetes, hypertension) and ocular (myopia, glaucoma, floppy iris syndrome, intraoperative complications during cataract surgery, YAG capsulotomy) conditions. RESULTS. The median period from cataract surgery to RD onset was 15 months. Retinal attachment was achieved in 92% of eyes. The final visual acuities were improved significantly from 1.7 logMAR to 0.7 logMAR. Silicon oil was used as a tamponade in 38 eyes and SF6 gas in 25 eyes. Better functional results were achieved with SF6 gas tamponade. No intraoperative complications were reported. Most of the patients were males (71%). Statistical analysis revealed that general and ocular conditions did not influence functional results. CONCLUSIONS. Primary PPV, especially with gas as a tamponade, is an effective procedure in the surgical treatment of pseudophakic RD. The advantages include good anatomical and functional outcomes and low complication rate. Neither clinical nor surgical factors have been identified as responsible for the visual outcomes.

Incidence of Retinal Detachment after Fellow-Performed Primary Pars Plana Vitrectomy

Background. Primary pars plana vitrectomy (PPV) is often performed by vitreoretinal fellows. We aimed to evaluate the incidence of retinal breaks and detachments (RD) after fellow-performed PPV. Methods. We reviewed 119 consecutive cases of standard 3-port primary PPVs on 115 patients at a teaching institution from 2003 to 2006. In all cases, the primary surgeon was a vitreoretinal fellow. Patients with previous RD were excluded. Cases were reviewed for postoperative retinal detachments, and all patients were followed for up to 1 year. Results. Intraoperative retinal breaks occurred in 5 of 119 eyes (4.2%). One break was associated with sclerotomy and 4 were not. Postoperative RD occurred in 8 of 119 eyes (6.7%). Two RDs were sclerotomy related, 5 were not, and 1 was of indeterminate origin. Conclusions. Incidence of retinal breaks and RD following primary PPV by vitreoretinal fellows is low and comparable to that of fellowship-trained surgeons.

Primary gas tamponade in the management of macular hole with retinal detachment in highly myopic eyes

Background We conducted a retrospective study to investigate the role of the primary gas tamponade on the final success rate of macular hole with retinal detachment (MHRD) in highly myopic eyes. Methods Retrospective chart review of the patients diagnosed as MHRD in highly myopic eyes between 1992 and 2008 was done. Fifty-three highly myopic eyes (>−6.0 diopter, >26 mm of axial length, or visible posterior staphyloma) with a retinal detachment resulting from a macular hole were included. The main outcome measures were anatomic reattachment and final visual acuity. Results Thirty-two of the 53 eyes received primary gas tamponade, and the reattachment of retina was achieved in 8 eyes (8/32, 25%). Twenty-one of the 53 eyes received primary pars plana vitrectomy (PPV) with or without scleral buckle, and the reattachment of retina was achieved in 12 eyes (12/21, 57.1%). The final success rate after adjunctive operations was 96.9% in the primary gas tamponade group, and 85.7% in the primary PPV group. Stability of vision (improved or maintained) was achieved in 78.1% of the primary gas group, and 66.7% in the primary PPV group. Conclusion Our results indicate that primary gas tamponade does not decrease the final success rate in the repair of MHRD in highly myopic patients. Since it is safe and time-saving, primary gas tamponade could be a good alternative for primary treatment in those who are not willing or eligible for more complicated surgeries.

Primary vitrectomy in retinal detachment: is scleral buckling still indicated?

Abstract Purpose The surgical management of rhegmatogenous retinal detachment has evolved due to introduction of primary pars plana vitrectomy (PPV). The choice of primary vitrectomy has grown over recent years even for managment of simple retinal detachment. Methods Review of reports on primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment. Evaluation of optimal indications of vitreectomy for specific types of retinal detachments. Results Comparaison of primary vitrectomy with scleral buckling had failed to demonstrate advantage of this method regarding anatomical and functional results. Vitrectomy avoids some of the complications associated with scleral buckling, such as diplopia, choroidal detachment, perforation of the sclera, abnormalities in the eyelid, but it carries higher risks of several other complications,including cataract formation in phakic eyes, glaucoma and other problems with tamponade, and new retinal breaks. Data from case series and randomized studies suggest that primary detachments in phakic eyes may be treated successfully with scleral buckling or vitrectomy, whereas vitrectomy appears to be preferable for corresponding detachments in pseudophakic eyes. Conclusion The choice of primary PPV in new uncomplicated retinal detachment remains to the surgeon's discretion and skills due to lack of controlled randomized trials covering the large spectrum of the retinal detachment pathology.

Vitrectomy cryo gas for the treatment of pseudophakic retinal detachment

Abstract Purpose The management of pseudophakic rhegmatogenous retinal detachment (PsRD) has represented a challenge for vitreoretinal surgeons for many years. Different surgical techniques have been used to manage PsRD including pneumatic retinopexy, scleral buckling (SB) and primary pars plana vitrectomy (PPV) with or without SB. Recent advances in the vitrectomy technique and instrumentation have contributed to the expanding role of PPV as a first‐line surgical treatment in cases of PsRD. Methods A potential advantage of PPV is removal of posterior capsular and vitreous opacities for better visualisation of the peripheral retina and the use of wide‐angle viewing systems and microscopic inspection of the fundus periphery with internal illumination and scleral identation during PPV. This allows for an accurate diagnosis of retinal breaks, their prompt treatment and thus high initial anatomical success. Results A meta‐analysis of published studies suggested that PPV with or without SB is more likely to achieve favorable anatomical and visual outcomes than conventional scleral buckling alone in uncomplicated PsRD. Recently published prospective or randomized clinical trials also found that primary PPV alone is at least as effective as scleral buckling for the treatment of PsRD. The Scleral Buckling versus Primary Vitrectomy in Rhematogenous Retinal Detachment study, found no difference in visual acuity between PPV and SB alone in pseudophakic eyes, but anatomic outcomes were better in the PPV group. Conclusion Primary vitrectomy without scleral buckling provides a high anatomic success rate in eyes with PsRD and is associated with few complications.

Pars Plana Vitrectomy without Long-Acting Gas Tamponade for Primary Rhegmatogenous Retinal Detachment

Purpose: To report the anatomical and visual results of primary pars plana vitrectomy (PPV) without long-acting gas tamponade to repair primary rhegmatogenous retinal detachments (RRDs). Methods: Twenty-seven consecutive patients (27 eyes) with peripheral retinal tears and new RRDs were treated according to the surgical protocol. Patients underwent PPV with fluid-air exchange and endolaser treatment to repair the RRD. Neither long-acting gas nor silicone oil tamponade was combined with PPV. All patients were followed from 6 to 26 months with an average follow-up of 11 months. Reattachment of the retina and visual outcome were compared to the results of previously published studies. Results: Reattachment was achieved in 24 of 27 eyes (89%) with a single operation, and in all 27 (100%) eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 0.4, and the median final visual acuity was 1.0. Conclusions: Primary PPV with fluid-air exchange alone and laser treatment is a safe, effective method for the repair of primary retinal detachments. The anatomical reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for primary PPV combined with long-acting gas tamponade.

The Expanding Role of Primary Pars Plana Vitrectomy in the Treatment of Rhegmatogenous Noncomplicated Retinal Detachment

The surgical management of rhegmatogenous retinal detachment has evolved dramatically during the past 2 decades. Investigators have introduced and refined alternative techniques to scleral buckling surgery including pneumatic retinopexy and primary pars plana vitrectomy (PPV). Rapid parallel developments in instrumentation, including wide-angle viewing systems, perfluorocarbon liquids, novel vitrectomy machines, intraocular tamponades, and endolaser photocoagulators have led to increasing sophistication in primary PPV surgical techniques for the treatment of rhegmatogenous uncomplicated retinal detachment. However, the precise role of primary PPV in new uncomplicated retinal detachment remains debatable owing to the lack of controlled randomized trials. This article examines primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment and presents the specific types of retinal detachments for which primary PPV may be optimal, according to personal and reported results, the surgical instrumentation and technique, as well as the complications and limitations of this surgical method

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

Objective To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes. Design Nonrandomized, prospective, comparative clinical trial. Participants Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol. Intervention Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months. Main outcome measures Reattachment of the retina and visual outcome were compared to previously published studies. Results Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was −0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes. Conclusion Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.