Pars plana vitrectomy with silicone oil in the management of combined rhegmatogenous retinal and choroidal detachment

Abstract

Results In a total of 10 eyes (77%) the first procedure produced anatomical success. Two eyes required a further procedure to achieve retinal reattachment, producing a final anatomical success rate of 92%. Patients with rhegmatogenous retinal detachment are occasionally found to have concurrent choroidal detachment (CD). These patients often present in an atypical way with pronounced uveitis, posterior synechiae, hypotony, deepened anterior chamber and pain. Patients with blue irides often have an apparent change in iris appearance, the affected eye taking a greenish tinge due to a highly proteinaceous aqueous. Retinal detachment may not be diagnosed if the view of the posterior segment is poor. From the point of view of surgical intervention, the presence of spontaneous CD is an important finding. Cases have in the past been associated with a poor prognosis when treated by 'conventional' (Le. Materials and methodsA retrospective review was carried out of the case notes of 13 consecutive patients who presented to one surgeon (G.R.K.) with rhegmatogenous retinal detachment combined with CD (RDCD), all of whom were treated with PPV and silicone oil. Patients presented between March 1993 and August 1999. The diagnosis of RDCD was based on clinical examination, supplemented by ultrasonography in cases where CD was suspected, but not definitively visualised, on ophthalmoscopy. Patients with RDCD presenting with a history in the affected eye of previous retinal detachment surgery, intraocular surgery (apart from cataract extraction) or trauma would have been excluded (in fact there were none). Two patients had grade B PVR at presentation. In 2 patients the RD did not involve the macula. Twelve patients had at least one flap tear. Most patients had several breaks (up to 10 in a single patient) including at least one flap tear. In 1 patient only one atrophic hole was identified (it is unknown whether the vitreous was detached pre-operatively in this case). No patient had a giant retinal tear or retinal dialysis. In 4 patients CDs were present in all four quadrants and in the remainder in between one and three quadrants.All patients were operated on by or under the care of one vitreoretinal surgeon (G.R.K.). The following basic operative technique was employed in all patients (Fig. 1)

Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment

“…2,16,17 Nevertheless, perioperative steroid has been widely used for preparation of surgery for RRD-CD patients. 2,[12][13][14][15]18,19 A short course of perioperative steroid may not be adequate in this regard as PVR formation is a continuing process after the surgery. 20 This may explain the findings in our study that preoperative steroid given about a week before surgery (PPV), in spite of regression of CD, appeared not to improve retinal reattachment rate, which is in agreement with a previous study before the era of PPV.…”

Outcomes of 23-gauge pars plana vitrectomy combined with phacoemulsification and capsulotomy without intraocular lens implantation in rhegmatogenous retinal detachment associated with choroidal detachment

“…[ 11 ] Using this surgical technique, proliferative and concentrated vitreous can be excised, and all retinal holes can be identified. [ 6 – 8 ] However, the detachment recurrence rate remains high when vitrectomy is performed alone. Several studies investigating methods to improve anatomical outcomes have been performed.…”

“…However, the 23G PPV + phaco + capsulotomy without IOL implantation had a higher reattachment rate, which was approaching to rates previously reported in the literature. [ 4 – 6 ] Vitrectomy and capsulotomy may improve anterior and base vitrectomy, which may decrease anterior PVR. [ 13 , 14 ] A study by Tseng et al reported that pseudophakic eyes exhibited a higher proportion of hypotony after retinal reattachment surgery than eyes without IOL implant.…”

“…[ 1 – 3 ] Primary vitrectomy results in a higher rate of retinal reattachment, reported to be as high as 77%. [ 4 – 6 ] Studies have been performed to investigate the outcomes of vitrectomy combined with other surgical techniques. It is reported that pars plana vitrectomy (PPV) combined with scleral buckling improved the reattachment rate in RRDCD.…”

Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment

“…RRDCD is an uncommon type of retinal detachment, characterized by rapid progression, poor functional and anatomic prognosis due to the more difficult visualization of the ocular fundus and retinal breaks as well as the high rate of postoperative PVR development. [34][35][36] The reattachment rate of RRDCD treated by SB (35.5%-52.4%) was lower compared to that of RRD without CD, according to Seelenfreund et al [27] After the introduction of primary PPV, the reattachment rate of RRDCD improved by up to 90% [34][35][36].…”