Preoperative Steroid Use in Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment after 23-Gauge Vitrectomy

Abstract

Background. Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is rare and the prognosis is poor. This retrospective study evaluated the effect of preoperative steroid on the clinical outcome of patients with RRDCD receiving 23-gauge pars plana vitrectomy (PPV). Methods. Sixty-six patients (67 eyes) with diagnosed RRDCD underwent 23-gauge PPV. The patients assigned to receive systemic or subtenon injection of preoperative steroids were considered Group A (35 eyes) and did not receive are considered Control Group B (32 eyes). Most patients in Group A received subtenon injection of glucocorticoids. The cyclodialysis angle was measured with ultrasound biomicroscopy. Preoperative, intraoperative, and postoperative data were compared. Results. The rates of retinal reattachment in Group A after the first and second operations were 68.8% (24/35 eyes) and 91.43% (32/35 eyes), respectively, which were not significantly different from that of Group B (78.1%, 25/32 eyes; 96.6%, 31/32 eyes). The logMAR (logarithm of the minimum angle of resolution) visual acuity in Group A (1.63 ± 0.75) was similar to that of Group B (1.34 ± 0.74). Postoperative intraocular pressure and ocular hypertension in Group A (17.94 ± 9.82 mmHg and 37.1%, respectively; 13/35 eyes) were comparable to that of Group B (20.93 ± 10.21 mmHg and 56.3%; 18/32 eyes). Logistic regression analysis showed that postoperative reattachment was negatively associated with preoperative cyclodialysis angle as measured with ultrasound biomicroscopy (P=0.048) but was not significantly associated with preoperative steroid use (P=0.907). Conclusions. Preoperative steroid use does not improve retinal reattachment and visual acuity in patients with RRDCD after 23-gauge PPV. Preoperative measurement of the cyclodialysis angle with ultrasound biomicroscopy may be useful for predicting clinical outcomes.

Function Evaluation of Diabetic Vitreous Hemorrhage After Vitrectomy

“…However, Wu et al (2017) conducted a study that included 82 eyes of 82 patients with vitreous haemorrhage or opacity due to ocular trauma, retinal detachment or retinal vascular diseases including diabetic retinopathy (non selective cases) and they compared these results with the values 2 weeks after vitrectomy operation. The authors revealed that there was no improvement or reduction in postoperative visual acuity [14].…”

“…Results were also in harmony with who showed that the preoperative visual electrophysiology was significantly correlated with the effectiveness of the operation. It is helpful in prognostic assessment of postoperative visual outcome [14].…”

Vitreoretinal Society of India practice pattern survey 2020: Surgical retina

“…[ 23 ] A few studies have shown it to improve the final reattachment rates, while some studies reported no improvement in retinal reattachment rates or visual outcomes. [ 23 24 25 ] Nonetheless, almost two-third of the VRSI survey respondents preferred to start the patient on oral corticosteroids for at least 3–7 days before the surgery.…”

Combined Rhegmatogenous Retinal and Choroidal Detachment

“…However, this did not significantly improve the retinal reattachment rate or VA at 3 months postoperatively. Wu et al 12 found that systemic, sub-Tenon or subconjunctival injection of glucocorticoids 3 days before surgery did not have any effect on rates of reattachment after PPV. On the contrary, Gui et al 17 reported a 95% final surgical success rate for patients with RRD-CD of whom 81% used oral prednisolone and 19% received intravitreal triamcinolone preoperatively.…”

“…2,8,9,11 Steroids have been administered through multiple routes in an attempt to improve surgical outcomes. 1,2,4,12–15 Various surgical approaches have been used including scleral buckle (SB), pars plana vitrectomy (PPV), pars plana lensectomy (PPL), and perfluorocarbon liquid (PFCL) tamponade. 15–18…”