Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases

Abstract

Primary pars plana vitrectomy is still flawed by a relatively high primary redetachment rate following the initial procedure. The advantages of the technique are a high final reattachment rate and relatively good functional results in a subset of patients with more complicated types of RRD. The risk factors for postoperative failures following PPPV for RRD match to a large extent those following scleral buckling surgery (SBS). Future improvements of the technique will have to focus on modifiable risk factors, such as details of the surgical procedures, surgical training and case selection, to distinguish it from SBS.

Royal College of Ophthalmologists' National Database Study of Vitreoretinal Surgery

“…[17][18][19] The results were similar to this study in showing that primary RD failure rates of less experienced surgeons were similar to those of more senior surgeons. One of these studies that comprised 512 patients with RD from one vitreoretinal centre showed that less experienced surgeons who had previously performed fewer than 30 PPVs independently prior to commencing the study had better outcomes than more experienced specialists.…”

“…Significant variation in reported primary RD failure exists. [10][11][12][13][14][15][16][17][18][19] This range may be due to variations in patient selection including surgical complexity, the definition of primary RD failure, the timeframe for reporting failure, and the inclusion or exclusion of cases with silicone oil in situ. A recent nationwide database study from Denmark found a 22% re-operation rate after RD surgery, using a large subset of 6,522 eyes of which 29.5% received silicone oil injection.…”

“…One of these studies that comprised 512 patients with RD from one vitreoretinal centre showed that less experienced surgeons who had previously performed fewer than 30 PPVs independently prior to commencing the study had better outcomes than more experienced specialists. 19 The authors speculated that this may have been due to case selection or the more frequent use of non-contact wide-angle viewing systems compared to more senior surgeons who used conventional contact lenses. 19 Similar to the grade of surgeon, the choice of scleral buckle vs. PPV did not significantly influence the primary anatomical success rate.…”

“…19 The authors speculated that this may have been due to case selection or the more frequent use of non-contact wide-angle viewing systems compared to more senior surgeons who used conventional contact lenses. 19 Similar to the grade of surgeon, the choice of scleral buckle vs. PPV did not significantly influence the primary anatomical success rate. In the UK, PPV surgery is currently the dominant technique used to treat RD and SB is increasingly reserved for non-complex RD in the absence of posterior vitreous separation in young patients.…”

“…The Royal College of Ophthalmologists has recommended primary RD success rate as one of the benchmark indicators for fitness to practise vitreoretinal surgery, although to date no acceptable boundaries for case mix adjusted RD success rates have been defined. 9 Several studies have documented the success rate of primary RD surgery [10][11][12][13][14][15][16][17][18][19][20] but few have analysed inter-surgeon variation and those that did included only experienced surgeons 16 or a few centres reporting only one technique: PPV. [17][18][19] The UK National Health Service (NHS) provides an ideal environment for "real-world" studies of vitreoretinal surgery outcomes.…”