Pars Plana Vitrectomy with and without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Retinal Detachment

Eshtiaghi, Arshia; Dhoot, Arjan S.; Mihalache, Andrew; Popović, Marko; Nichani, Prem; Sayal, Aman P; Yu, Hannah J.; Wykoff, Charles C.; Kertes, Peter J.; Muni, Rajeev H.

doi:10.1016/j.oret.2022.02.009

Cited by 18 publications

(7 citation statements)

References 28 publications

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“…17 Two recent meta-analyses of approximately 16,000 eyes (including 8 randomized clinical trials) reported comparable outcomes with and without encirclage, sometimes with added complications of encircling band-like epiretinal membrane, band migration, strabismus, infection, etc., besides delayed postoperative recovery. 22,23…”

Section: Discussionmentioning

confidence: 99%

Medium-Term Perfluoro-N-Octane as Rescue Postoperative Tamponade for Very Complex Retinal Detachments

Shukla¹,

Dhawan

Kalliath

2023

Retina

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Purpose: To report the anatomical and functional outcomes of medium-term perfluoro-noctane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs).Methods: We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA).Results: The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was #counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. bestcorrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA $20/200 and 21 (60%) regained ambulatory vision ($5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications. Conclusion:We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.RETINA 43:905-912, 2023C omplex or complicated retinal detachments (RDs) have been variously defined in the literature as those associated with proliferative vitreoretinopathy (PVR), trauma, inflammation, giant retinal tears, and postsurgical recurrences. [1][2][3][4] The unifying pathology in this heterogeneous compilation is PVR. The 5% to 10% cases of RDs that develop PVR remain a formidable challenge for vitreoretinal surgeons, notwithstanding the decades of innovations and improvements in surgical techniques, equipment, and adjuvants. 1 With progressive resurgeries and recurrent PVR, the chances of retinal reattachment and recovery of meaningful vision become bleaker. 3,5 At some point, the surgeon either declines further intervention 5 or takes the chance, sometimes only to abandon the procedure on the From the

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Section: Discussionmentioning

confidence: 99%

Medium-Term Perfluoro-N-Octane as Rescue Postoperative Tamponade for Very Complex Retinal Detachments

Shukla¹,

Dhawan

Kalliath

2023

Retina

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“…The 36 selected studies reported on a total of 3720 eyes with an overall primary success rate of 94.1%, rivaling that reported for primary rhegmatogenous retinal detachment despite the increased surgical complexity of the former. 2 Less impressive, however, were the functional results with an average final Snellen equivalent of just better than 20/200, the Inter-national Classification of Diseases definition of severe visual impairment for a better-seeing eye. 3 Better preoperative visual acuity was the only factor found to be correlated with final postoperative vision after multivariate analysis.…”

Section: Storey Pp Termentioning

confidence: 98%

“…The main outcome measures were single-surgery anatomic failure rates and final visual acuity. The 36 selected studies reported on a total of 3720 eyes with an overall primary success rate of 94.1%, rivaling that reported for primary rhegmatogenous retinal detachment despite the increased surgical complexity of the former . Less impressive, however, were the functional results with an average final Snellen equivalent of just better than 20/200, the International Classification of Diseases definition of severe visual impairment for a better-seeing eye .…”

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confidence: 99%

What Defines Successful Surgery for Diabetic Tractional Retinal Detachment?

Casparis

2023

JAMA Ophthalmol

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“…PPV plus SB had a higher single operation success rate, but the final reattachment rate was similar between the two groups. 101 A recent Cochrane review concluded that PR had a lower reattachment rate and a higher recurrence rate but a lower burden of post-operative complications compared to SB. 102 Data from a commercial insurance database from the USA showed that almost 30% of cases managed by primary PR compared to 20% of cases managed by either SB or PPV required a reoperation within 90 days of the primary repair.…”

Section: Outcomes Of Retinal Re-attachment Proceduresmentioning

confidence: 99%

“…24 , 107 Recent systematic reviews and meta-analysis of randomized clinical trials comparing SB, PR and PPV for RRD reported that there were no significant differences in final visual acuity between the different techniques. 99 , 101 , 108 Despite retinal re-attachment and excellent visual acuity, patients may be dissatisfied following retinal reattachment surgery due to aniseikonia and vertical metamorphopsia. Clinical examination with indirect ophthalmoscopy or slit-lamp biomicroscopy of the macular area usually reveals no abnormalities.…”

Section: Functional Outcomesmentioning

confidence: 99%

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Pimentel¹,

Shih²,

Wu³

2022

OPTH

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Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.

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Pars Plana Vitrectomy with and without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Retinal Detachment

Cited by 18 publications

References 28 publications

Medium-Term Perfluoro-N-Octane as Rescue Postoperative Tamponade for Very Complex Retinal Detachments

Medium-Term Perfluoro-N-Octane as Rescue Postoperative Tamponade for Very Complex Retinal Detachments

What Defines Successful Surgery for Diabetic Tractional Retinal Detachment?

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

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