Management of Inferior Breaks in Pseudophakic Rhegmatogenous Retinal Detachment With Pars Plana Vitrectomy and Air

Abstract

To determine the role of pars plana vitrectomy without scleral buckling and air as a tamponade with 24 hours of prone positioning in the management of inferior breaks in primary pseudophakic rhegmatogenous retinal detachment. Methods: Prospective, noncomparative, interventional case series. Fifteen consecutive eyes (15 patients) with primary pseudophakic rhegmatogenous retinal detachment with causative breaks located between the 4-o'clock and 8-o'clock positions underwent pars plana vitrectomy with air tamponade. The prone position was maintained for 24 hours. Anatomic and functional results are presented. Results: The anatomic reattachment rate was 93.3% after 1 procedure and 100% at the 6-month visit. Mean preoperative best-corrected visual acuity was 20/60 (range, 20/400 to 20/25) and mean postoperative bestcorrected visual acuity was 20/30 (range, 20/100 to 20/20). In 1 case the retina redetached at the second week because of an undetected break. Postoperative epiretinal membrane was observed in 1 case. Conclusion: Pars plana vitrectomy and air tamponade with only 24 hours of prone positioning postoperatively is effective in the management of primary pseudophakic rhegmatogenous retinal detachment with causative breaks between the 4-o'clock and 8-o'clock positions.

Retrospective Comparison of 25-Gauge Transconjunctival Sutureless Vitrectomy to 20-Gauge Vitrectomy for the Repair of Pseudophakic Primary Inferior Rhegmatogenous Retinal Detachment

“…Other series have also demonstrated efficacy of PPV alone in the management of inferior RRD with inferior retinal breaks. [32][33][34][35] In this series, we present a retrospective single-surgeon series comparing transconjunctival sutureless (25-gauge) PPV with standard 3-port 20-gauge PPV in the management of RRDs associated with inferior retinal breaks. Our overall single procedure reattachment rate of 87% and our ultimate attachment rate of 97.5% approach that of other authors and with no statistical difference in outcomes when comparing smaller and larger gauge vitrectomy systems.…”

Primary vitrectomy with Densiron-68 for rhegmatogenous retinal detachment

“…Different surgical techniques have been advocated for this complicated subset of patients, ranging from vitrectomy without internal tamponade [13], vitrectomy with gas tamponade but without scleral buckling [19,22], and combined scleral buckling for primary cases [1]. A novel approach is the use of heavy silicone oil tamponades in such cases [15].…”

“…The majority of RRD is associated with breaks above 10 to 2 clock hours, where the use of gas or silicone oil is well-tolerated and well-accepted in the clinical management [3,4,10,13,14]. RRDs with retinal breaks between 4 to 8 clock hours are generally more difficult to treat, due to limited tamponade effects of conventional gas or silicone oil tamponade agents in the usual supine or upright postoperative positioning of the patient.…”

Emulsification of Densiron-68 used in inferior retinal detachment surgery

“…Recently, tamponade of primary inferior RDs using intraocular gases 16,17 or even air 18,19 alone has been advocated with good functional and anatomical outcomes. Twelve out of our 40 identified cases had Densiron insertion for primary RD with inferior breaks and no PVR.…”

“…In the light of recent reports of successful functional outcomes for primary inferior RD repair using gases or air, [16][17][18][19] it would seem reasonable to reserve Densiron use for the more complex cases such as those with inferior PVR or trauma. Although Densiron fills a clinically important void in vitreous substitutution, further large-scale studies are necessary to determine the incidence of significant Densiron emulsification and its effects on clinical outcomes.…”