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

Abstract

There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

“…In phakic eyes, an increased risk of incomplete vitreous removal and intraoperative breaks with PPV may mediate decreased reattachment rates, even if done in combination with SB [17,55,56]. In the subgroup of pseudophakic eyes, there is a lower risk of incomplete vitreous removal, which was consistent with the observed lack of significant difference between comparators for both primary and final reattachment rates [57,58]. Of note, the use of sectoral and/or encircling buckles was inconsistent among studies with some studies not outlining specific details regarding the procedure performed.…”

Comparison of the Safety and Efficacy of a 3-Dimensional Heads-up Display vs a Standard Operating Microscope in Retinal Detachment Repair

“…VAs of counting fingers, hand motions, and light perception were assigned logMAR values of 2.0, 3.0, and 3.3, respectively. 13 After the distribution of continuous data graphically (histogram and boxplots) was verified and a Shapiro-Wilk normality test was performed, appropriate descriptive terms and statistical tests were used. Categorical variables were assessed using the Pearson chi-square test with Yates continuity correction when applicable.…”

“…VAs of counting fingers, hand motions, and light perception were assigned logMAR values of 2.0, 3.0, and 3.3, respectively. 13…”

Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study

“…Several variables including extent of retinal detachment, previous intraocular surgery, high myopia, and preoperative best-corrected visual acuity have been associated with worse functional outcomes after surgical correction of RRD [ 7 , 8 ]. Macular detachment has also been identified as a major negative prognostic indicator for visual recovery after RRD correction, and standard practice utilizes macular inclusion as a measurement for determining surgical urgency [ 6 ].…”

“…However, the precise amount of tolerable delay in fovea-involving RRD remains unclear and controversial. While previous studies have concluded functional damage following a macular detachment event is permanent, others have shown that poorer visual outcomes are associated with longer durations of preoperative macular detachment [ 8 – 10 ]. Mechanistically, studies in animal and cell models have demonstrated that photoreceptor cell death is immediately induced, as early as 12 h after the RD event, and peaks after 2 or 3 days, however, the photoreceptor degeneration processes are complex and are currently not fully understood [ 11 – 14 ].…”