Inferior retinotomy and silicone oil tamponade for recurrent inferior retinal detachment and grade C PVR in eyes previously treated with pars plana vitrectomy or scleral buckle

Abstract

BackgroundOne of the most challenging problems in vitro-retinal surgery is the recurrence of retinal detachment in the context of high-grade proliferative vitreoretinopathy (PVR). The aim of our retrospective study was to assess the surgical outcomes of pars plana vitrectomy, 180° inferior retinotomy and silicone oil tamponade combined with phacoemulsification and IOL implantation for recurrent inferior retinal detachment with grade C PVR in phakic eyes. The study was carried out at tertiary referral centre - University Hospital of Rome “Tor Vergata”.MethodsRetrospective analysis of 33 eyes affected by recurrent inferior retinal detachment and grade C PVR after primary encircle scleral buckling (SB group – 12 eyes), or pars plana vitrectomy (PPV group – 21 eyes). All patients subsequently underwent PPV and silicone oil tamponade at our Institution. The first outcome measure was retinal reattachment, and second outcomes were reoperation rates, best-corrected visual acuity (BCVA) and postoperative complications.ResultsAll patients in the SB group and 19 (90 %) patients of the PPV group achieved retinal reattachment. Final BCVA was better in the SB group (p = 0.045). Two eyes in the PPV group required a third vitrectomy with heavy silicone oil tamponade. Postoperative complications included silicone oil in a deep anterior chamber (3 eyes in each group), untreatable hypotony in 1 eye in the PPV group (that led to enucleation due to phthisis bulbi), and elevated intraocular pressure in 3 patients (2 eyes in the PPV group).ConclusionsPhacoemulsification with IOL implant, PPV with silicone oil tamponade associated with 180° inferior retinotomy may lead to better anatomical success in patients who have previously undergone SB procedure for inferior retinal detachment repair compared with eyes that underwent a primary PPV.

Vitrectomy with scleral buckling versus with inferior retinectomy in treating primary rhegmatogenous retinal detachment with PVR and inferior breaks

“…Also, the final anatomical success was more for the buckle group (95.2%) than the retinectomy group (90%) with no statistical significant difference (p = 0.49). Similar to our results but in recurrent cases, Mancino et al showed that successful attachment for cases with recurrent RD after vitrectomy using inferior retinectomy was higher in cases with previous buckle than cases with previous vitrectomy [18].…”

The Outcomes of Recurrent Retinal Detachment Surgery and the Effect of the First Surgeon to the Final Outcomes

“…The final anatomical success of vitrectomy for recurrent and complicated retinal detachment cases was reported as 93% by Quiram et al, 80% by Pournaras et al, 90-100% by Mancino et al, around 70% by Wei et al and 65% by Karakaya et al in previous studies. [9][10][11][12] Our final anatomical success rate was similar to the studies reported above. Pournaras et al evaluated the anatomical and functional outcomes for recurrent retinal detachment surgery in a retrospective study, which included 70 patients.…”

“…The most important reason for primary anatomical failure for RD surgery is PVR and it occurs in approximately 5-10% of the patients. [9][10] The primary success rate of vitrectomy in patients with recurrent RD with PVR was reported between as low as 14% to as high as 80%. [10] The final anatomical success rate was increased by 10%…”

Anatomical success rate of pars plana vitrectomy for treatment of complex rhegmatogenous retinal detachment

“…In addition, several reports about surgery outcomes from complex retinal detachment surgery using heavy SO have shown success rates ranging between 39 and 92%, with different number of surgeries being required and a high incidence of complications being reported [42, 46–49]. Mancino et al recently reported 100 and 90.4% success rate of vitrectomy with inferior 180° peripheral retinectomy and SO tamponade in subgroups of patients with recurent retinal detachment and PVR grade C after failed primary scleral buckle surgery and PPV, respectively [50]. …”