Drainage Retinotomy Is a Risk Factor for Surgical Failure After Pars Plana Vitrectomy in Patients With Primary Uncomplicated Rhegmatogenous Retinal Detachment

Abstract

Purpose: To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD).Methods: This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had $3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated.Results: We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08-5.15, P = 0.0314) and a propensity scorematching analysis (odds ratio 3.20, 95% confidence interval 1.14-9.04, P = 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04-3.57, P = 0.0358). Conclusion:The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.

SF6 compared to C2F6 for inferior rhegmatogenous retinal detachment repair; The Manchester Pseudophakic Retinal Detachment Study

“…This finding appears more significant considering the potential concerns related to the intraocular use of PFCL 30 and the suggested association of drainage retinotomy with surgical failure and epiretinal membrane development. 31 We recognize that our study has several limitations that are intrinsic to retrospective analysis. These include lack of standardization, incomplete data, selection bias, cases lost to follow-up, and multiple operating surgeons over a 10-year period.…”

“…This finding appears more significant considering the potential concerns related to the intraocular use of PFCL 30 and the suggested association of drainage retinotomy with surgical failure and epiretinal membrane development. 31…”

Surgical drainage methods during pars plana vitrectomy for rhegmatogenous retinal detachment: a systematic review and meta-analysis

“…Previous studies have established that PR is a significant risk factor for ERM formation, which is similar to the results observed in this study. 24,25 ERM formation is marked by migration and proliferation of cells to the macula, such as retinal pigment epithelium cells, glial cells, fibroblasts, and inflammatory cells. 26 It has been hypothesized that the use of a PR for drainage dislodges retinal pigment epithelial cells, releases inflammatory cells, and leads to glial cell activation.…”

Impact of drainage retinotomy on surgical outcomes of retinal detachment: insights from the Japan-Retinal Detachment Registry

“…The influence of drainage retinectomy on the primary success rate remains a subject of debate. Ohara et al 7 recently identified drainage retinotomy as a risk factor for surgical failure after PPV in patients with uncomplicated RRD. They proposed that avoiding drainage retinotomy could enhance surgical success.…”

“…Some recent retrospective reports have suggested that drainage retinotomy is a risk factor for the development of an ERM 7 , 20 . Previously, Ishikawa et al reported that drainage retinectomy are more likely to develop ERM after vitrectomy using J-RD registry data.…”