Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C ₃ F ₈ ) for retinal detachment

Abstract

Purpose:To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD).Materials and Methods:A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C3F8) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded.Results:Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better.Conclusions:PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.

Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

“…Kobashi et al [ 16 ] reported that although eyes with superior breaks exhibited slightly better results than eyes with inferior breaks, the primary anatomical success rate of the repair of RRD did not significantly differ between the eyes with inferior and superior breaks, which was in line with other previous studies [ 14 , 17 , 28 ]. On the other hand, Goto et al reported that the anatomical success rate of primary vitrectomy for RRD with inferior breaks was lower than that of RRD with superior breaks (80% versus 98%) [ 29 ].…”

“…Over the last 40 years, there have been a variety of advancements in vitrectomy surgery including intraocular gases, increased vitreous cutter speeds, wide angle viewing systems, perfluorocarbon liquids, lighted and curved instruments, sutureless vitrectomy, and chandelier lights. These advancements have improved the surgeon's ability to perform a thorough evaluation of the peripheral retina due to the higher magnification and excellent illumination, which is crucial for detecting and treating all retinal breaks and relieving the vitreoretinal traction [ 14 ].…”

“…Other studies have determined that neither the macula state nor the lattice degeneration can be considered as risk factors for the primary success rate in RRD surgery [ 14 , 17 ]. Our current results are in agreement with these studies.…”

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

“…reported after extensive vitreous removal [10,20,22]. A different study [29] utilized transillumination by light pipe to indent the eye in combination with TA to enhance visualization of the vitreous base for closer vitreous shaving; they reported less detachments after changing to the novel method.…”

Vitrectomy in high myopia: a narrative review

“…Although controversial, use of small gauge instruments may reduce the incidence of postoperative cataract [ 71 , 72 ]. Peripheral vitrectomy with meticulous vitreous shaving is highly beneficial in eyes with RD, especially in complicated cases, in order to prevent redetachment or proliferative vitreoretinopathy (PVR) [ 73 – 75 ]. In eyes with cataract, combined phacoemulsification and pars plana vitrectomy is a good option, since it allows a better shaving of vitreous base.…”