Primary Vitrectomy in Complicated Rhegmatogenous Retinal Detachment – A Survey of 205 Eyes

Abstract

Introduction: In a few types of rhegmatogenous retinal detachment (RRD), scleral buckling (SB) has a lower success, and, here, pars plana vitrectomy (PPV) is a good alternative option. This survey reviews the indications and the surgical outcome of primary PPV with internal tamponade. Patients and Methods: We reviewed 205 eyes operated by primary PPV for RRD at the Department of Ophthalmology of the Philipps University Marburg between the years 1990 and 1997. The indications of PPV were: holes greater than 90°; holes posterior to the equator; proliferative vitreoretinopathy grade C; pseudophakic status. Results: A complete reattachment of the retina after absorption of the gas or after silicone oil removal was achieved by 1 operation in 146 eyes (71.2%) and in 195 eyes (95.2%) by a second intervention. Conclusion: Although SB is the standard procedure for the treatment of RRD, complicated cases can be treated successfully with primary PPV.

Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): recruitment list evaluation. Study report no. 2

“…Numerous studies have been published recommending one of the two methods [1,4,13,14,20,24,26,27,29,30,32]. We could identify no consensus among several editorial comments on this issue [6, 15-18, 33, 34].…”

Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases

“…To improve the success rates of PPPV in patients with breaks including the inferior quadrants, several suggestions have been published, including support of these breaks with an additional encircling band [12,30,46], long-acting tamponades, e.g. C 3 F 8 , C 2 F 6 , silicone or heavy silicone [1,32,39,44], and strict positioning of the patient [33,39]. In contrast to our findings, two recent series achieved relatively high success rates with PPPV without additional measures for detachments with inferior breaks [33,41].…”

“…While some authors are of the opinion that additional buckling might improve the results of the surgery overall or in selected cases [1,11,26,30], others argue that with modern vitrectomy techniques and a thorough cleaning of the vitreous base, additional buckling might not be necessary, but harmful [9,32,41]. In a prospective, non-randomised study, Pournaras and Kapetanios compared PPPV with PPPV and additional SBS in pseudophakic patients and did not find any statistically significant differences between the two groups [29].…”

Characteristics of rhegmatogenous retinal detachment and their relationship to visual outcome

“…With primary anatomical success rates ranging from 81-92% in uncomplicated cases, [1][2][3][4][5][6][7] 65-70% in high-risk eyes, or 75% when no break is found, 2,[8][9][10][11][12] visual recovery is not certain. Even with successful re-attachment of the retina, the visual acuity (VA) may not return to the pre-morbid level.…”