Pseudophakic rhegmatogenous retinal detachment: combined pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone

Abstract

There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.

Outcomes of primary rhegmatogenous retinal detachment repair with extensive scleral-depressed vitreous removal and dynamic examination

“…This work evaluated the results of 187 consecutive eyes of 180 patients that underwent surgical repair for primary RRD. The single surgery anatomic success rate was 99.5%, keeping in line with several studies in the literature [ 1 , 3 , 10 – 12 , 16 – 18 , 21 , 25 , 26 ]. Of the 117 eyes with macula-detached retinal detachment, 116 (99.1%) were reattached with 1 operation, and of the 70 eyes with macula-attached retinal detachment, all (100%) were also reattached with 1 operation.…”

“…Shaving of the vitreous base with scleral depression and dynamic peripheral examination are important in identifying retinal breaks that are not seen preoperatively [19]. Indeed, "extensive", "careful", or "meticulous" shaving of the vitreous and inspection of the peripheral retina has led to high surgical reattachments rates [11,[20][21][22]. While these terms have no strict surgical definition, they likely represent extensive inspection of the peripheral retina as well as shaving of all possible vitreous at the base, while minimizing the possibility of causing any iatrogenic retinal breaks.…”

Modified Controlled Encircling Scleral Buckle for Retinal Detachment

“…Encircling procedures are particularly indicated in cases with multiple breaks in different quadrants and diffuse vitreoretinal pathologic conditions such as extensive lattice degeneration or vitreoretinal degenerations, proliferative vitreoretinopathy, and young age, although people do not always agree with the indications. [3][4][5][6][7] Although there is a big debate in our community whether buckling or vitrectomy is the best technique, similar rates of primary success (80%) are reported using national databases in the United States. 1 Since select subpopulations of patients may do better with one versus the other, it is important for the person skilled in the art of vitreoretinal surgery to do both.…”

“…Encircling procedures are particularly indicated in cases with multiple breaks in different quadrants and diffuse vitreoretinal pathologic conditions such as extensive lattice degeneration or vitreoretinal degenerations, proliferative vitreoretinopathy, and young age, although people do not always agree with the indications. 3 –7…”

Le traitement du décollement de rétine du pseudophaque: vitrectomie sans indentation épisclérale VERSUS Chirurgie Ab externo

“…Plusieurs études ont démontré les avantages supérieurs de l'abord ab interno par rapport à l'abord ab externo chez les patients pseudophaques [12-14]. La vitrectomie permet de meilleurs résultats anatomiques, moins d'anomalies réfractives, meilleure gestion et traitement des tractions vitré-rétiniennes, l'élimination des cellules ou de l'hémorragie intra vitréenne, meilleure visibilité de la rétine périphérique dont l'examen est souvent gêné par une opacification capsulaire secondaire ,des aberrations optiques générés par les bords de l'implant ou une mauvaise dilatation pupillaire et enfin la possibilité de réaliser une capsulotomie postérieure si nécessaire[13-16]. Dans l'étude réalisée par Campo et al qui a porté sur 225 cas de DRP opéré par vitrectomie en première intention, le succès anatomique était de 88% [17].…”