Comparative study of endolaser versus cryocoagulation in vitrectomy for rhegmatogenous retinal detachment

Abstract

Background To investigate the influence of different types of retinopexy on the outcome of rhegmatogenous retinal detachment (RRD) repair. Method All patients with RRD who underwent pars plana vitrectomy (PPV) between January 2013 and December 2017 were included. Analysed surgical factors were types of retinopexy (cryocoagulation, endolaser, combined). Subgroup analysis was performed in patients with primary proliferative vitreoretinopathy (PVR), and/or the necessity of a primary silicone oil fill. Results A total of 1017 eyes with retinal detachment were included. The predominant type of retinopexy used during PPV was cryocoagulation in 492 eyes, followed by a combined cryocogulation/endolaser in 306 eyes and laserretinopexy in only 219 eyes. Overall, the re-detachment rate was 10.1%. In most of the cases (53.6%) the main reason for re-detachment was insufficient retinopexy, followed by a PVR-reaction in 37.3%, and new site break in 9.1%. No significant difference in the rate of re-detachment was found between the different types of retinopexy ( p = 0.309). However, subgroup analysis showed a significantly higher rate of re-detachment in patients with a primary PVR ( p = 0.0003), and in the group with silicone oil as the primary tamponade ( p = 0.0001). Conclusion The data suggests that the type of retinopexy has little relevance for the surgical outcome of PPV for the primary RRD. However, patients with primary PVR and primary silicone oil fills were at a significantly increased risk for re-detachment.

Predictive Risk Factors for Retinal Redetachment Following Uncomplicated Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment

“…Both types of retinopexy cause an alteration in the blood–retinal barrier, which leads to a breakdown of this barrier and frees retinal pigment epithelium cells, which can lead to PVR [ 29 ]. However, in our study population, neither retinopexy type showed a higher risk for failure [ 30 ].…”

“…However, although not statistically significant, cryocoagulation had a slightly higher rate for insufficiency of the retinopexy and redetachments at a different location caused by another break ( Table 2 ). In our experience, most redetachments caused by insufficient retinopexy are caused by overtreatment with cryocoagulation causing an atrophic scar around the retinal break [ 30 ].…”

<p>Successful Treatment of Peripheral Proliferative Vitreoretinopathy with Cryocoagulation During Retinal Detachment Repair – A New Surgical Technique</p>

“…One of the major causes for re-detachment is still PVR. 2 Recently, efforts have been directed toward the chemical inhibition of cellular proliferation and membrane contractions in PVR. 6 However, none of these agents has had a sufficient impact on the prevention of PVR and consequently have not been adopted by vitreoretinal surgeons.…”

“…Proliferative vitreoretinopathy (PVR) is a severe complication of rhegmatogenous retinal detachment (RRD), and is the most common reason for failure after surgical treatment. [1][2][3] Several studies have confirmed the hypothesis that PVR occurs as a reparative process induced by retinal breaks and excessive inflammatory reaction. 4 Clinically, early stages of PVR are characterized by an increased reflectance and a cellophane appearance of the inner retinal surface.…”

“…5 Recent published series suggest that the frequency of PVR remains largely unchanged in primary rhegmatogenous retinal detachment, with the incidence ranging from 5.1 to 11.7%. [1][2][3] In particular, intraretinal PVR can be a surgical challenge as is it not possible to peel due to the lack of a preretinal membrane. In addition, these PVR folds are often located peripherally or mid-peripherally and are therefore not really suitable for retinectomy.…”