Outcome of primary vitrectomy in phakic patients aged younger than 50 years with rhegmatogenous retinal detachments

Cataract progression after primary pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachments in young adults

BACKGROUND

Scleral buckling is typically implemented to repair rhegmatogenous retinal detachments (RRD) in young patients. Therefore, there is limited data on post-pars plana vitrectomy (PPV) cataract formation in this cohort. We report the rates and risk factors of cataract progression after PPV for RRD repair in young eyes.

METHODS

Retrospective single-center cohort study. Medical records of patients between the ages of 15 to 45 undergoing PPV for uncomplicated RRD between 2014 and 2020 were reviewed.

RESULTS

Twenty-eight eyes from 26 patients met inclusion criteria. Cataracts developed in 20/28 (71%) eyes after PPV. After PPV, nuclear sclerotic cataract (NSC) rates were higher in patients above 35 (65%) compared to below 35 years (18%) (p = 0.024). Cataracts developed more frequently after macula-off RRDs (88%) compared to macula-on RRDs (50%) (p = 0.044) with NSC more common in macula-off detachments (p = 0.020). At postoperative month 2, all eyes with C3F8 gas developed cataracts compared to 59% of eyes with no gas (p = 0.040).

CONCLUSIONS

Cataract formation was common and frequent after PPV. After PPV, young eyes and macula-on detachments developed cataracts less frequently than older eyes and macula-off detachments. If appropriate, a shorter acting gas tamponade should be considered in young eyes to minimize cataract formation.

PHACOVITRECTOMY VERSUS LENS-SPARING VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT REPAIR ACCORDING TO THE SURGICAL EXPERIENCE

PURPOSE

To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience.

METHODS

We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared.

RESULTS

Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively).

CONCLUSION

Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.