Primary vitrectomy without scleral buckling for pseudophakic rhegmatogenous retinal detachment

Visual outcomes of macula-involving rhegmatogenous retinal detachment in patients with and without age-related macular degeneration

BACKGROUND

The prognosis for patients with macula-off rhegmatogenous retinal detachment (RRD) and concomitant age-related macular degeneration (AMD) is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD.

METHODS

This was a retrospective chart review of 1149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls), and 29 AMD eyes. The main outcome measure was postoperative visual acuity following pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB in control eyes versus AMD eyes. This was compared using Fisher's exact test.

RESULTS

There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a worse visual outcome overall (p = 0.0048). A similar percentage of AMD versus non-AMD eyes achieved vision better than 20/40. More patients in the non-AMD group achieved a final visual acuity between 20/40 and 20/200. Of patients with AMD, more had vision worse than 20/200 though 58% maintained functional vision (better than 20/200). Those without AMD had a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023).

CONCLUSIONS

Though postoperative visual acuity was worse overall in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is likely a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD.

Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes, anatomic, and visual outcomes

INTRODUCTION

To investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes.

METHODS

We retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed.

RESULTS

A total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery.

CONCLUSION

The incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.

Functional recovery after macula involving retinal detachment and its correlation with preoperative biomarkers in optical coherence tomography

To introduce an ETDRS grid-based classification for macula involving retinal detachment (MIRD) with or without center (foveal) involvement and to identify biomarkers in preoperative optical coherence tomography (OCT) associated with a favorable postoperative functional outcome in eyes with center involving retinal detachment (CIRD). One hundred and two eyes of 102 consecutive patients (f/m: 35/67) with primary rhegmatogenous retinal detachment, preoperative evidence of MIRD (perifoveal involvement of ≤ 6.0 mm), and successful retinal surgery were included in this retrospective cohort study. Eyes were assigned to 5 grades of MIRD (G1–G5), based on the extent of detachment in the ETDRS grid. Eyes with a detached foveal status (CIRD) were assigned to G4 or G5. In CIRD, the following OCT biomarkers were quantified and correlated with mean BCVA (logMAR) at 3 months postsurgery, using univariate and multivariable regression models: grade of detachment, extent of intraretinal edema, height of foveal detachment, subretinal folds, and epiretinal membrane. Forty-one of 102 eyes (40.2%) presented with an attached foveal status, defined as either outer (G1: 11.8%) or inner (G2: 18.6%) macular involvement or fovea-threatening MIRD (G3: 9.8%). Sixty-one eyes (59.8%) showed CIRD (G4 or G5). Eyes with CIRD had significantly worse postoperative BCVA than eyes without foveal involvement (0.355 logMAR vs. 0.138 logMAR, p<0.001). If CIRD was limited to three outer ETDRS quadrants (G4), mean BCVA was better compared to CIRD involving all four ETDRS quadrants (G5) (0.254 logMAR vs. 0.522 logMAR, p<0.001). Reading ability (BCVA ≤ 0.4 logMAR) was restored in 97.6% of eyes with G1–G3 compared to 86.9% of eyes with G4 (p=0.072) and 52.4% of eyes with G5 (p<0.001). In multivariable regression analysis of eyes with CIRD, a lower grade of detachment (G4 vs. G5: p<0.05) and lower extent of cystoid edema (focal/none vs. wide: p<0.001) were both associated with better postoperative function. The functional outcome after MIRD may be worse in the presence of foveal involvement (CIRD), but a lower grade of detachment and the absence of intraretinal edema can predict a good recovery in spite of CIRD.

Successful surgical outcomes after 23-, 25- and 27-gauge vitrectomy without scleral encircling for giant retinal tear

PURPOSE

Retinal detachment due to giant retinal tears (GRTs), tears larger than 90°, is rare and difficult to treat. Here, we show and compare surgical results of 23-, 25- and 27-gauge (G) micro-incision vitrectomy surgery (MIVS) for GRT.

STUDY DESIGN

Retrospective and interventional case series.

METHODS

Retrospective review of 41 eyes of 38 patients with GRT who underwent MIVS. Surgical outcomes after MIVS, including reattachment rates and postoperative complications, were compared between instrument gauges. All patients were followed for at least 6 months postoperatively.

RESULTS

MIVS with 23G, 25G and 27G instruments was performed in 7, 19 and 15 eyes, respectively. Silicone oil (SO) was used in 34 of 41 eyes (83%) with a mean removal time of 43.8 days after first surgery. Best-corrected visual acuity (BCVA) was recovered or maintained in 39 eyes (95%). Reattachment was attained after initial surgery in 38 of 41 eyes (93%) (23G: 6/7 [86%]; 25G: 17/19 [89%]; 27G: 15/15 [100%]). Final reattachment was eventually achieved in all eyes (two eyes needed support from scleral encircling). Postoperative complications occurred in 16 eyes (39%) (23G: 3/7 [43%]; 25G: 8/19 [42%]; 27G: 5/15 [33%]), including macular pucker, cystoid macular edema, macular hole, subretinal perfluorocarbon liquid, retinal folds, vitreous hemorrhage and redetachment. There were no significant differences between the three groups in rate of high myopia, GRT size, operation time, phacovitrectomy rate, SO usage rate, initial reattachment rate, final reattachment rate, preoperative BCVA, final BCVA or rate of postoperative complications.

CONCLUSION

Despite occasional postoperative complications, primary MIVS, regardless of gauge size, appears to be a safe and feasible option for GRT surgery.

Primary Retinal Detachment Outcomes Study: Pseudophakic Retinal Detachment Outcomes: Primary Retinal Detachment Outcomes Study Report Number 3

PURPOSE

This study evaluates outcomes of comparable pseudophakic rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).

DESIGN

Multicenter, retrospective, interventional cohort study.

PARTICIPANTS

Data were gathered from patients from multiple retina practices in the United States with RRD in 2015.

METHODS

A large detailed database was generated. Pseudophakic patients with RRD managed with PPV or PPV-SB were analyzed for anatomic and visual outcomes. Eyes with proliferative vitreoretinopathy, giant retinal tears, previous invasive glaucoma surgery, and ≤90 days of follow-up were excluded from outcomes analysis. Single surgery anatomic success (SSAS) was defined as retinal attachment without ongoing tamponade and with no other RRD surgery within 90 days.

MAIN OUTCOME MEASURES

Single surgery anatomic success and final Snellen visual acuity (VA).

RESULTS

A total of 1158 of 2620 eyes (44%) with primary RRD were pseudophakic. A total of 1018 eyes had greater than 90 days of follow-up. Eyes with proliferative vitreoretinopathy, previous glaucoma surgery, and giant retinal tears were excluded, leaving 893 pseudophakic eyes eligible for outcome analysis. A total of 461 (52%) were right eyes. A total of 606 patients (67%) were male, with a mean age of 65±11 years. Pars plana vitrectomy and PPV-SB as the first procedure were performed on 684 eyes (77%) and 209 eyes (23%), respectively. The mean follow-up was 388±161 days, and overall SSAS was achieved in 770 eyes (86%). Single surgery anatomic success was 84% (577/684) for PPV and 92% (193/209) for PPV-SB. The difference in SSAS between types of treatment was significant (P = 0.009). In eyes with macula-on RRD, SSAS was 88% in eyes treated with PPV and 100% in eyes treated with PPV-SB (P = 0.0088). In eyes with macula-off RRD, SSAS was 81% in eyes treated with PPV and 89% in eyes treated with PPV-SB (P = 0.029). Single surgery anatomic success was greater for PPV-SB than PPV for inferior (96% vs. 82%) and superior (90% vs. 82%) detachments. Mean final VA was similar for PPV (20/47) and PPV-SB (20/46; P = 0.805).

CONCLUSIONS

In pseudophakic RRDs, SSAS was better in patients treated with PPV-SB compared with PPV alone, whereas visual outcomes were similar for both groups.

Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment

Purpose

To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base in vitrectomy for rhegmatogenous retinal detachment (RRD).

Patients and methods

This was a retrospective study of patients who underwent vitrectomy for RRD without proliferative vitreoretinopathy. Barrier laser was applied as 3-4 rows surrounding the break at the end of fluid-air exchange. For the FBL, 3-4 rows of laser burn were additionally made about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base. The primary outcome was single surgery success rate (SSSR) between two groups: FBL and conventional barrier laser (CBL) groups.

Results

Overall, 118 eyes were included; 50 eyes in the FBL group and 68 eyes in the CBL group. SSSR was 100% (50/50) in the FBL group and 91.2% (62/68) in the CBL group with a significant difference (p=0.038). Four eyes of the recurrent cases in the CBL group were related to reopening of the break. All eyes achieved reattachment, and no differences were found in postoperative visual acuity at 6 months.

Conclusion

FBL on the vitreous base was efficacious in improving the anatomical success rate of vitrectomy.

Management of recurrent rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) repair is one of the most common vitreoretinal surgeries a surgeon performs. In an ideal scenario, RRD can be repaired with a single surgical intervention; however, despite excellent skill, flawless technique, and the introduction of high-end technology, up to 10% of cases require additional interventions to ultimately repair recurrent detachments. It is thus important to study the outcomes of multiple interventions to understand whether performing repeat vitrectomy on patients with a history of failed surgeries is worthwhile. Thus, recurrent retinal detachment (re-RD) remains a significant challenge for vitreoretinal surgeons as well as the patients considering the economic and the emotional burden of undergoing multiple interventions. The advent of microincision vitrectomy system, perfluorocarbon liquids, and effective intraocular tamponades has opened new doors for managing re-RDs. In this article, we have reviewed and summarized the various causes and approaches for management for optimal anatomical and functional outcomes.

Preoperative Electrophysiological Characterization of Patients with Primary Macula-involving Rhegmatogenous Retinal Detachment

Purpose:

To determine 1) which components of retinal function are impaired after rhegmatogenous retinal detachment, 2) which outer retinal pathways (rod- or cone-driven) are more severely affected, and 3) whether there is concomitant inner retinal dysfunction.

Methods:

We conducted a prospective observational study in a large academic institution. We performed preoperative electroretinography on eight patients to assess outer and inner retinal function. In all cases, a comparison between the eye with the detached retina and the control fellow eye was made.

Results:

Eyes with a detached retina had significantly lower a-wave and b-wave amplitudes with respect to both rod- and cone-dominated testing parameters (P < 0.05) and reduced 30 Hz flicker responses compared to fellow eyes (P < 0.05); the effect size was similar for all significantly reduced parameters (r~0.6). There were no significant differences between eyes with detached retinas and control fellow eyes with respect to b/a-wave ratios, a-wave latencies, or b-wave latencies.

Conclusion:

Patients with rhegmatogenous retinal detachment have preoperative outer retinal dysfunction equally affecting both rod- and cone-driven pathways, and they have minimal inner retinal dysfunction.

COMPLEX RETINAL DETACHMENT IN PHAKIC PATIENTS: Previtrectomy Phacoemulsification Versus Combined Phacovitrectomy

Previtrectomy cataract surgery was associated with less extensive postoperative posterior synechia, however, its final functional and anatomical outcomes were not significantly different from those of combined phacovitrectomy. Both approaches were efficacious.

Purpose:

To assess the impact of phacoemulsification performed one week before pars plana vitrectomy versus combined phacovitrectomy on postoperative anterior segment status and final functional and anatomical outcomes in phakic patients affected by complex rhegmatogenous retinal detachment.

Methods:

The authors retrospectively reviewed the records of 59 phakic patients affected by complex rhegmatogenous retinal detachment. Twenty-nine patients underwent cataract surgery 7 days before vitrectomy (preemptive cataract surgery—Group 1), whereas 30 patients underwent combined phacovitrectomy (Group 2). Preoperative, intraoperative, early- and late-postoperative outcomes were measured and compared.

Results:

Numbers of previous retinal surgical procedures, nuclear sclerosis grade, proliferative vitreoretinopathy grade, eyes with inferior breaks, surgical time, and ratio of silicone oil/gas tamponade were all similar between the two groups. After surgery, there was less extension of posterior synechia in Group 1. There was no significant difference in fibrin, number of patients with posterior synechia, final intraocular pressure, retinal redetachment rate, final retinal status, or final best-corrected visual acuity.

Conclusion:

Preemptive cataract surgery was associated with less extensive postoperative posterior synechia, however, its final functional and anatomical outcomes were not significantly different from those of phacovitrectomy. Both approaches were efficacious.

Anatomical and Functional Results Following 23-Gauge Primary Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Superior versus Inferior Breaks

PURPOSE

In this retrospective study, we evaluated the anatomical and functional outcomes of patients with rhegmatogenous retinal detachment primarily treated with pars plana vitrectomy in regard to the location of the breaks. Methods. 160 eyes were enrolled in this study, divided into two groups based on break location: the superior break group (115 eyes) and the inferior break group (45 eyes). The main endpoint of our study was the anatomical success at 3 months following surgery.

RESULTS

Primary retinal reattachment was achieved in 96.5% of patients in group A and in 93.3% in group B (no statistically significant difference, OR 1.98, 95% CI: 0.4, 7.7). Mean BCVA change and intraoperative complication rate were also not statistically significantly different between the two groups (p > 0.05, OR: 1.0, 95% CI: 0.9, 1.01, resp.). Statistical analyses showed that macula status, age, and preoperative BCVA had a significant effect on mean BCVA change (p = 0.0001, p = 0.005, and p = 0.001, resp.).

CONCLUSION

This study supports that acceptable reattachment rates can be achieved using PPV for uncomplicated RRD irrespective of the breaks location and inferior breaks do not constitute an independent risk factor for worse anatomical or functional outcome.

Pars plana vitrectomy with partial tamponade of filtered air in Rhegmatogenous retinal detachment caused by superior retinal breaks

BACKGROUND

To investigate the anatomic and functional outcomes of pars plana vitrectomy (PPV) with partial tamponade of filtered air for rhegmatogenous retinal detachment (RRD) caused by superior retinal breaks.

METHODS

Retrospective, comparative, consecutive case series study. Patients with RRD caused by superior retinal breaks undergone PPV with partial tamponade (Group A) and whole tamponade (Group B) of filtered air were included. The main outcomes were primary and final success rates, best corrected visual acuity (BCVA), and rate of postoperative cataract surgery.

RESULTS

Forty-one patients (41 eyes) were included in Group A and 36 patients (36 eyes) were included in Group B. There were no significant differences in primary or final success rates between Groups A and B (P = 0.618 and P = 1.000, respectively). The patients in Group A experienced quicker postoperative vision improvement (from the Week 1 follow-up) than the patients in Group B (from the Month 3 follow-up). The postoperative cataract surgery rate of Group A (7/31) was lower than that of Group B (13/26) (P = 0.031).

CONCLUSIONS

PPV with partial tamponade of air is effective in achieving a high anatomic success rate, quicker postoperative vision improvement, and lower rate of postoperative cataract surgery in RRD caused by superior retinal breaks.

Regeneration of Photoreceptor Outer Segments After Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

PURPOSE

To investigate the regeneration of the cone outer segments in eyes after surgery for fovea-off rhegmatogenous retinal detachment with an adaptive optics (AO) fundus camera and to correlate these findings with the findings of optical coherence tomography (OCT).

DESIGN

Retrospective, observational case series.

METHODS

Medical charts of 21 eyes of 21 patients who had undergone surgery for fovea-off rhegmatogenous retinal detachment were retrospectively studied. Cone mosaic images were obtained with an AO fundus camera. Cone packing density at 2 degrees from the fovea within the previously detached area was measured 6 and 12 months after surgery. Retinal thicknesses between the interdigitation zone and the retinal pigment epithelium (IZ-RPE) and between the ellipsoid zone and the retinal pigment epithelium (EZ-RPE) were measured in OCT images.

RESULTS

Cone density 12 months after surgery was significantly increased from that at 6 months (P = .001), but was still significantly lower than that of normal fellow eyes (P < .001). IZ-RPE and EZ-RPE thickness significantly increased from 6 to 12 months (P = .045, P = .033, respectively), and these values were not significantly different from those of normal fellow eyes. Multivariate analysis showed that cone density at 12 months was significantly associated with IZ-RPE thickness (P = .002), and increases in cone packing density were significantly associated with increases in IZ-RPE thickness (P = .001).

CONCLUSIONS

Recovery of cone packing density measured by AO was associated with structural recovery of the outer retina observed in OCT, suggesting regeneration of the photoreceptor outer segment after surgery.

Anatomical and functional outcomes of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment

Retinal detachment is the separation of the sensory retina from the retinal pigment epithelium by subretinal fluid. There are several types of retinal re-attachment surgery, including scleral buckling (SB), pneumatic retinopexy, and vitrectomy (with or without SB). The objective of this study was to compare anatomical and visual outcomes between patients with pseudophakic rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) with silicone oil (SO) or perfluoropropane (C3F8) gas tamponade and pseudophakic RRD patients who underwent SB surgery. We evaluated retrospectively 101 pseudophakic RRD patients from a single center. The patients were classified into three groups according to the surgical procedure performed: PPV + Silicone - patients who underwent PPV with SO tamponade; PPV + Gas - patients who underwent PPV with perfluoropropane gas tamponade; and SB group - patients who underwent SB surgery. The groups were compared with regard to primary and final anatomical and visual outcomes. The number of patients in PPV + Silicone, PPV + Gas, and SB group was 39 (38.6%), 32 (31.7%), and 30 (29.7%), respectively. The mean follow-up period in PPV + Silicone, PPV + Gas, and SB group was 33.95 ± 23.58, 32.62 ± 10.95, and 33.76 ± 16.62 months, respectively. No significant difference was observed between the groups neither with regard to primary and final anatomical and visual success rates nor in relation to the recurrence rate of retinal detachment. According to our anatomical and visual outcome results, either of the three methods (i.e., PPV + Silicone, PPV + Gas, or SB) can be used in the treatment of pseudophakic retinal detachment.

Primary vitrectomy for rhegmatogenous retinal detachment in pseudophakic eyes: 20-gauge versus 25-gauge vitrectomy

PURPOSE

To report anatomical and functional outcome of 20-gauge versus 25-gauge primary pars plana vitrectomy for management of complex rhegmatogenous retinal detachment in pseudophakic eyes.

METHODS

Prospective single-centre randomized comparative pilot trial. Fifty patients with retinal detachment (RD) not complicated by proliferative vitreoretinopathy grade B or C, who cannot be treated with a single meridional sponge, were randomized (1:1) from November 2006 to January 2010 to either 20-gauge or 25-gauge vitrectomy as first surgical intervention and followed up over a 12-month period, evaluating change in best-corrected visual acuity, anatomical success and intraocular pressure dysregulation.

RESULTS

Mean visual acuity improved by 0.88 (SD 0.67) from 1.22 logMAR (SD 0.63) to 0.34 logMAR (SD 0.31) in the 20-gauge group and by 0.53 (SD 0.91) from 0.86 logMAR (SD 0.73) to 0.34 logMAR (SD 0.46) in the 25-gauge group. Final anatomical success rate was 100% and primary success rate was 69% at 6 months of follow-up. In the 20-gauge group, the retina was attached after one single procedure in 18 eyes (72%) and in 21 eyes (84%) of the 25-gauge group. Two patients in the 25-gauge group had hypotony at the first postoperative day which normalized within 6 weeks.

CONCLUSION

In our series, transconjunctival sutureless 25-gauge and 20-gauge vitrectomy showed comparable results in pseudophakic RD not suitable for single sponge surgery with respect to visual outcome and retinal reattachment. Postoperative hypotony does not seem to be a significant problem of transconjunctival sutureless vitrectomy.

Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C3 F8) for retinal detachment

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.

Pseudophakic rhegmatogenous retinal detachment: combined pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone

PURPOSE

To compare the outcomes of combined vitrectomy + scleral buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD).

METHODS

Cases included 65 eyes of 63 patients with primary non-complex pseudophakic RRD. The first group underwent combined vitrectomy + SB between January 2010 and August 2012, and the second group was treated with vitrectomy alone between September 2012 and October 2013. The medical records of the patients were reviewed for preoperative examinations, follow-up examinations (including final visual acuity [VA]), appearance of redetachment and complications. The main outcomes were recurrent retinal detachment, complications, and VA improvement.

RESULTS

The rate of single-surgery anatomic success was non-significantly lower in the combined vitrectomy + SB group compared with the vitrectomy alone group - 75.8 % versus 84.4 % respectively (P = 0.683). Complications were significantly more frequent in the former compared to the latter (P = 0.014). The final VAs were 0.580 (logMAR) and 0.486, respectively (P = 0.258). VA improvement of ≥3 lines was achieved in 48.5 % and in 50 % of the eyes respectively (P = 0.769).

CONCLUSIONS

There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.

Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery

OBJECTIVE

This study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases.

DESIGN

Retrospective series in a tertiary care centre.

PARTICIPANTS

One hundred and twenty consecutive patients.

METHODS

The medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed.

RESULTS

The single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point.

CONCLUSIONS

Consequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.

Vitrectomy combined with endolaser or an encircling scleral buckle in primary retinal detachment surgery: a pilot study

PURPOSE

To compare pars plana vitrectomy and 360° endolaser therapy with pars plana vitrectomy and an encircling scleral buckle for the treatment of primary rhegmatogenous retinal detachments in a randomized pilot study including 60 patients.

METHODS

Main outcome measures were single-surgery anatomic success rate and final best-corrected visual acuity at 6 months follow-up. Cofactors analysed were complication rates, patients' comfort, refractive outcome and macula status assessed using a spectral-domain optical coherence tomography.

RESULTS

With differences between both treatment groups regarding type of the retinal detachment, localization of retinal tears (p = 0.0085) and the choice of the intraocular tamponade (p < 0.0202), there were no significant differences between the single-surgery anatomic success rate (93.33% both groups, p = 1.0) and the visual acuity at final follow-up (≤0.3 logMAR [logarithm of minimum angle of resolution] in 66.67% in the endolaser group versus 40.0% in the scleral buckle group, p = 0.0514). Questionnaire responses showed lower levels of patients' discomfort in the endolaser group. A significant difference between both groups was found in the refractive error change after surgery (-0.20 ± 0.51 dioptres in the endolaser group versus -0.88 ± 0.88 dioptres in the scleral buckle group, p = 0.0003).

CONCLUSION

Primary vitrectomy combined with 360° endolaser therapy seems to be as effective as vitrectomy combined with an encircling scleral buckle in patients with rhegmatogenous retinal detachment, with possible benefits of an improved patients' comfort and a more stable refractive status after surgery.

Combined cataract extraction and vitrectomy for macula-sparing retinal detachment: visual outcomes and complications

Purpose

To evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment.

Methods

The results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 µm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated.

Results

In 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324).

Conclusions

In patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.

Encircling Narrow Band versus Buckle for Retinal Detachments with Intrabasal or Unseen Retinal Breaks

Purpose:

To compare the results of narrow encircling band surgery with standard encircling scleral buckling for retinal detachments (RDs) with intrabasal or unseen breaks.

Methods:

In a retrospective study, eyes with intrabasal or unseen breaks underwent narrow band implantation (group N) or standard encircling buckling plus wide tire placement (group W) and were followed for at least one year.

Results:

A total of 112 eyes including 39 eyes in group N and 73 eyes in group W were studied. Preoperatively visual acuity of eyes in group N was significantly better (1.55 ± 0.9 vs. 1.93 ± 0.9 logMAR, P = 0.043). The two study groups (N and W) were comparable in terms of the extent of RD (2.8 ± 0.96 vs. 2.8 ± 0.93 quadrants), interval to surgery (88.3 ± 176.4 vs. 71.9 ± 135.4 days) and percentage of visible breaks (56.4% vs. 63%), respectively (all P values > 0.05). More atrophic holes were present in group W and more dialyses were reported in group N. The single operation success rate at 12 months was 69.2% in group N and 74% in group W (P = 0.1). The single operation success rate for eyes with unseen breaks was also comparable (66.7% vs. 85.7%, P = 0.157). Final corrected visual acuity was also similar (0.63 ± 0.44 vs. 0.85 ± 0.69 log MAR). The only factor influencing success rate was the type of retinal breaks (P = 0.04). Type of scleral buckling did not affect the single operation success rate (P = 0.460).

Conclusion:

Narrow encircling band surgery is a possible option with acceptable single operation success rate for RDs with intrabasal or unseen breaks.

Impact of Duration of Macula off Rhegmatogenous Retinal Detachment on Visual Outcome

Objective: To assess impact of duration of macular detachment on visual outcome after scleral buckling for retinal detachment with macula off.

Methods: Prospective, descriptive case series was conducted at Ophthalmology Department Dow University of Health Sciences, Civil Hospital Karachi and Al Noor Eye Clinic Karachi from May 2012 to June 2013. Five groups were made according to period of macular detachment. Best corrected Visual acuity (BCVA) was main outcome measure. P value < 0.001 was considered significant.

Results: Mean duration of macula off was 17.0±4.0 (SD) days. Mean pre-operative VA in patients with immediate, early, intermediate, delayed or late group were 2/60, 2/60, Counting figure (CF) 3 meters (m), CF2 m and Hand Movement (HM) respectively. Only 48.48% patients of those repaired within 7 to15 days had significantly better (P < 0.001) BCVA (6/9-6/18) than the other groups. Only 19.35% patients of intermediate group achieved BCVA 6/18-6/24 (P < 0.001) which was comparatively better than the delayed and late group.

Conclusions: Scleral buckle surgery for macular-off Rhegmatogenous Retinal Detachment has good post-operative visual outcomes if repaired within two weeks.

An analysis of the outcomes for patients with failed primary vitrectomy for rhegmatogenous retinal detachment

PURPOSE

Our aim was to identify the timing of retinal redetachments and the prognosis for affected patients.

METHODS

Retrospective review of electronic patient records and casenotes from two centres. Inclusion criteria were failed primary vitrectomy for rhegmatogenous retinal detachment during a 12-year period. Failure was defined as re- or persistent detachment of the retina prior to a further procedure or at final follow-up.

RESULTS

The records of 133 cases of failed primary PPV for RRD were analysed. The mean age at time of primary surgery was 62.9 years, and mean follow-up was over 3 years from the date of primary surgery. In 72.9 % of cases, the redetachment was diagnosed within 2 months of the primary surgery. Eighty-five percent were diagnosed within 3 months, 89.5 % within 4 months, and 97.7 % within 6 months. For patients in whom the primary surgery had failed, the rates of attached retina at final follow-up were 80.5 %, or 68.8 % if PVR B/C were present at the time of primary surgery. The final follow-up success rates (attached retina with no tamponade) were 66.2 % for all patients, and 59.4 % for the subset with PVR B/C at the time of primary surgery respectively. Of the total, 33.8 % had one further vitreoretinal procedure, 30.8 % two more, 25.6 % three more, and 5.3 % had four or more. Visual outcome was better with final success (attached retina and no tamponade, p < 0.0001) and worse with PVR B/C evident on diagnosis of failed primary surgery (p < 0.0001).

CONCLUSIONS

A short duration of follow-up can over-estimate surgeon success rates for retinal detachment repair. For patients in whom primary surgery has failed, the prognosis for ultimate success is markedly lower than for primary surgery, and most patients require two or more further procedures to achieve this.

Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments

PURPOSE

To examine the effect of symptom duration on visual and anatomical outcomes following pars plana vitrectomy repair of primary macula-off rhegmatogenous retinal detachments.

METHODS

This is a retrospective, consecutive, interventional case series. All eyes underwent repair of macula-off rhegmatogenous retinal detachment with a 20-gauge, 23-gauge, or 25-gauge standard 3-port pars plana vitrectomy. Eyes with previous retinal surgery, giant retinal tear, Grade C or higher proliferative vitreoretinopathy, or less than 6 months of follow-up were excluded from the study. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the duration of macular detachment symptoms. The secondary outcomes studied were single surgery anatomical success and complication rates. Visual acuity analysis was performed on all eyes that were pseudophakic by the final follow-up visit.

RESULTS

Overall, 81 eyes of 81 patients met inclusion criteria, with a mean follow-up length of 55 months (range, 6-171 months) and mean duration of macular detachment symptom of 12 days (range, 1-64 days). The mean final BCVA was 20/40 (range, 20/20 to hand motion), with 70% (n = 57) of all patients obtaining 20/40 or better final BCVA. Patients with symptom duration of 6 days or less achieved better final BCVA (mean 20/25, n = 34) than patients with longer symptom duration (mean 20/50, n = 47) (t-test, P = 0.0030; α = 0.005). After 7 days of macular detachment, no significant difference was seen in final BCVA (t-test, P > 0.05). The overall single surgery anatomical success rate was 88% (71 of 81 eyes). There was no correlation between the single surgery anatomical success rate and duration of macular detachment symptom (Fisher's exact test, P > 0.10).

CONCLUSION

Primary pars plana vitrectomy repair results in good final visual outcome for patients with primary macula-off rhegmatogenous retinal detachments. Surgical repair within 6 days of the symptom onset yielded better visual outcomes. After 7 days, visual outcome was not affected by the timing of the surgical repair. Anatomical outcome following pars plana vitrectomy repair is not affected by symptom duration.

Effect of prophylactic 360° laser treatment for prevention of retinal detachment after phacovitrectomy: (Prophylactic 360° laser treatment for prevention of retinal detachment)

Background

To investigate the effect of intraoperative 360° laser retinopexy anterior to the equator for the prevention of retinal detachment after phacovitrectomy.

Methods

The patients were part of two consecutive case series cohorts in macular hole (MH) and rhegmatogenous retinal detachment (RRD), one which did not receive intraoperative prophylactic 360° laser, and one which received intraoperative prophylactic 360° laser. For the 360° laser treatment group, three rows of medium-white burns were positioned anterior to the equator. The baseline characteristics and the risk of retinal detachment over time were analyzed and compared between the groups.

Results

Prophylactic intraoperative 360° laser treatment was performed on 77 MH cases (67.3 years) and compared to a control group of 35 MH cases (65.8 years). Additionally, prophylactic intraoperative 360° laser treatment was performed on 108 RRD cases (64.0 years) and compared to 270 RRD cases (64.4 years). The 360° laser group showed a significant reduction (0%, 0/77 eyes) in the rate of the incidence of retinal detachment after vitrectomy at 12 months after surgery in MH cases, compared with the control group (5.7%, 2/35 eyes) (p = 0.034). Kaplan-Meier survival analysis demonstrated that the rate of retinal detachment in the control group was significantly higher than that in the 360° laser group (p = 0.035). There was no significant difference between the groups in RRD cases (p = 0.092).

Conclusions

Intraoperative 360° laser retinopexy following phacovitrectomy resulted in a significant reduction in the rate of postoperative retinal detachment in MH cases.

Cost comparison of scleral buckle versus vitrectomy for rhegmatogenous retinal detachment repair

PURPOSE

To estimate and compare the costs of scleral buckle (SB) and pars plana vitrectomy (PPV) for treatment of rhegmatogenous retinal detachment (RRD).

DESIGN

Cost analysis based on published prospective data comparing SB and PPV for RRD repair.

METHODS

The costs of initial surgery, postoperative retina-affecting procedures, and eventual cataract extraction resulting from SB and PPV for RRD repair were estimated for both phakic and pseudophakic or aphakic patients and then were compared. A univariate sensitivity analysis also was performed to examine the sensitivity of our estimations.

RESULTS

When considering all costs, SB was 10.7% less expensive than PPV for RRD repair in phakic patients, whereas PPV was 12% less expensive than SB for RRD repair in pseudophakic or aphakic patients. These conclusions were robust in the sensitivity analysis.

CONCLUSIONS

SB seems to offer a modest cost savings over PPV for repair of RRD in phakic patients. However, in pseudophakic and aphakic patients, PPV seems to be less expensive than SB.

Neuronal and glial alterations in complex long-term rhegmatogenous retinal detachment

PURPOSE

To explore neuronal and glial alterations in eyes with complex long-term rhegmatogenous retinal detachment (RRD).

METHODS

Morphological analysis was performed on eight retinal specimens derived from patients treated with peripheral retinectomy for RRD complicated by retinal shortening or retinal thinning. All eyes had undergone previous surgeries including silicone oil tamponade, and had a median total detachment time of 2.5 months (range 2-12). Specimens were examined with hematoxylin and eosin staining and immunohistochemistry directed against activated Müller cells, ganglion cells, rod bipolar cells, and photoreceptors.

RESULTS

Retinal specimens displayed severe loss of photoreceptor and rod bipolar cells. Remaining neuronal cells exhibited disorganized perikarya and neurites with disruption of the normal retinal lamination. Müller cell activation was evident in all specimens with subretinal and epiretinal hypertrophy present in tissue derived from shortened retinal detachments.

CONCLUSION

Long-term RRD leads to retinal remodeling characterized by loss of first and second order retinal neurons, disruption of the entire retinal lamination and gliosis. The severity of histopathological changes indicates that anatomical as well as functional recovery of the involved retina is precarious. The findings may be important when devising surgical strategies to avoid permanent retinal detachment.

Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review

BACKGROUND

Persistent subretinal fluid after rhegmatogenous retinal detachment (RRD) surgery is responsible for delayed recovery, and may affect the final visual outcome. Cause, consequences, and treatment remain elusive.

DESIGN

Literature review and case series.

METHODS

We reviewed the pathophysiological principles and therapeutic options from the literature, and we report the results from a subretinal fluid cytology study. Nine eyes from nine patients with macula-involving RRD underwent surgical repair. The cellular content of subretinal fluid (SRF) was studied by electron microscopy and anti-rhodopsin immunostaining. All eyes were assessed postoperatively with optical coherence tomography for the detection of persistent submacular fluid (PSF) (Ethics Committee Ghent University Hospital, registration number B6702006169).

RESULTS

Certain patient characteristics as well as surgical methods were implicated. PSF appears to occur more frequently in patients with longstanding detachments treated with buckling surgery. Several therapeutic options have been suggested but safety and efficacy remain unclear. We found PSF in three eyes on postoperative OCT scans, which corresponded to the three cell-rich subretinal samples.

CONCLUSIONS

PSF after successful RRD repair seems to be related to fluid composition. We hypothesize, in the absence of an effective treatment, that a modified surgical drainage, including a washout of the subretinal space, could evacuate the subretinal fluid more completely, and may prevent this complication.

Surgical outcomes for primary rhegmatogenous retinal detachments in patients with pseudophakia after phacoemulsification

PURPOSE

To evaluate the clinical features and surgical outcomes for primary rhegmatogenous retinal detachments (RDs) in patients with pseudophakia after phacoemulsification.

METHODS

The medical records of patients with pseudophakia after phacoemulsification and intraocular lens implantation who had undergone surgery for primary rhegmatogenous RDs with a minimum duration of follow-up of 12 months were reviewed retrospectively.

RESULTS

A total of 104 patients were enrolled in this study and 106 eyes were analyzed. Post-operative retinal attachment was achieved in 87 of the eyes (82.1%) and the final visual acuities (logarithm of the minimum angle of resolution) were improved to 0.65 ± 0.49 from the baseline measurement of 1.51 ± 1.14 (p < 0.001). Re-operations were performed in 24 of the eyes (22.6%) and there were no visible retinal breaks in 30 of the eyes (28.3%). The failure to identify a retinal break during surgery was associated with a lower rate of retinal reattachment, worse final visual acuity, and a higher rate of re-operation (p = 0.002, p = 0.02, and p = 0.002, respectively). The location of the identified retinal break was more common in the superotemporal quadrant than in the other quadrants.

CONCLUSIONS

The inability to identify a retinal break during surgery was associated with a poor final outcome. Other factors were less important for the functional and anatomic success in patients with pseudophakic RDs.

Trends in primary retinal detachment surgery: results of a Bicenter study

PURPOSE

To assess trends and outcomes in retinal detachment (RD) surgery based on a retrospective, interventional, bicenter study.

METHODS

Baseline demographic data, surgical procedures, and outcomes from 230 patients with a diagnosis of primary rhegmatogenous RD, who underwent surgery between January 2007 and December 2008 at the Rudolf Foundation Clinic, Vienna (Center 1) and the Weill Cornell Medical College, New York, (Center 2) were analyzed using a regression model.

RESULTS

Besides the baseline parameters, lens status (P = 0.01), refraction (P = 0.01), retinal tears (P < 0.02), proliferative vitreoretinopathy (P = 0.02), and previous treatment (P < 0.02), the primary RD procedure (P < 0.0001) was significantly different between the 2 centers. In Center 1, scleral buckling was the most common primary RD procedure (66.19%) compared with vitrectomy (82.42%) in Center 2. Primary retinal reattachment (88.49% Center 1 vs. 84.62% Center 2, P = 0.43) and best-corrected visual acuity at the final follow-up (best-corrected visual acuity ≥ 0.3 logarithm of minimum angle of resolution 48.92% Center 1 vs. 47.25% Center 2, P = 0.78) were not significantly different between the 2 centers.

CONCLUSION

Although there is a trend toward primary vitrectomy, scleral buckling was preferred in the center in Vienna and primary vitrectomy in the center in New York. Despite the different primary RD procedures, anatomical and visual outcomes were comparable.

Pseudophakic rhegmatogenous retinal detachment in a large Asian tertiary eye centre: a cohort study

BACKGROUND

To determine the incidence and identify risk factors for the development of rhegmatogenous retinal detachment in patients who had cataract surgery at the Singapore National Eye Centre between 2001 and 2003.

DESIGN

Retrospective case-control study.

PARTICIPANTS

All patients who had cataract surgery between 2001 and 2003 and subsequently retinal detachment surgery in the same eye, between 2001 and June 2008, at Singapore National Eye Centre.

METHODS

Review of case records.

MAIN OUTCOME MEASURES

Incidence of posterior capsular rupture and retinal detachment.

RESULTS

Thirty-nine eyes, out of 24 846 cataract operations performed between 2001 and 2003, developed rhegmatogenous retinal detachment in the follow-up period from 2001 to 2008 (cumulative incidence 0.16%, 95% confidence interval 0.11-0.21%). Of the 508 eyes with posterior capsular rupture during cataract surgery, nine developed retinal detachment (cumulative incidence 1.77%, 95% confidence interval 0.87-3.23%). Men were more likely to develop retinal detachment (P < 0.001). On Kaplan-Meier survival analysis, younger patients had a higher probability of retinal detachment in comparison with older subjects (P < 0.001). Similarly, eyes with posterior capsular rupture during surgery had shorter interval duration to retinal detachment, compared with eyes that did not (P = 0.002). When compared with patients more than 70 years of age, younger patients had significantly higher hazard ratios of retinal detachment (hazard ratio 19.7, 95% confidence interval 3.6-107.3, P < 0.05).

CONCLUSION

The incidence of pseudophakic retinal detachment in our institution is low. Posterior capsular rupture during surgery, men and younger age at time of surgery increases the risk of developing retinal detachment, and careful observation for the occurrence of retinal detachment may be warranted in these groups of patients.

Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment

PURPOSE

To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less.

METHODS

This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid-gas exchange, and a minimum follow-up of 6 months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole, diabetic retinopathy, aphakic eyes, giant tears, or posteriorly located breaks precluding treatment using transconjunctival cryotherapy.

RESULTS

Baseline examination disclosed pseudophakia in 77.1%, high myopia in 11.4%, 2.7 ± 2.2 retinal breaks/eye, attached macula in 37.1%, and PVR grade B in 24.3% of the cases. The mean operative time and intraoperative complication rate (11.4%) were similar in both groups. In the 23-G group, we noted three cases of iatrogenic retinal tears and one case of choroidal detachment secondary to a dislodgment of the infusion line. Suturing the sclerotomy sites or the conjunctiva was required in 5.7 and 51% of the eyes, respectively. The single reattachment rate was similar in both groups, 74.3% in the 20-G group, and 80% in the 23-G group. The final anatomical success rate was 97% in the two groups. Mean preoperative VA of 1.2 ± 0.9 logMAR improved similarly in both groups to 0.4 ± 0.4 at the 6-month visit. A final vision of 20/40 or better was achieved similarly in 62.9% of the eyes in the 20-G group and 60% in the 23-G group.

CONCLUSIONS

Twenty-three-gauge PPV provides anatomical and visual results similar to the 20-G technique for the management of uncomplicated rhegmatogenous RD.

Anatomic and visual outcomes in early versus late macula-on primary retinal detachment repair

PURPOSE

The purpose of this study was to describe the single surgery anatomic success rates and visual outcomes of primary macula-on retinal detachment repaired within 24 hours compared with later than 24 hours.

METHODS

This is a retrospective, comparative, interventional, consecutive case series. All eyes underwent primary surgical repair of the macula-on retinal detachment with a scleral buckle, pars plana vitrectomy, or combination of both procedures. The duration from the initial examination to the time of surgical repair was categorized as early (<24 hours) versus late (>24 hours).

RESULTS

Sixty-six eyes, 42 phakic and 24 preoperative pseudophakic, had retinal detachment repair with a median time to surgery of 1.0 ± 2.1 days (0.8 ± 0.4 days in early group versus 3.7 ± 2.2 days in late group, P < 0.005). The overall single surgery anatomic success rate was 59 of 66 eyes (89%). The single surgery anatomic success rate between the early (32 of 37 [87%]) versus late (27 of 39 [93%]) repair groups showed no statistical difference (P = 0.45). The mean time of follow-up was 13.1 months (range 0.9-39.2 months) with the mean final logarithm of the minimum angle of resolution best-corrected visual acuity showing no statistical difference between the 2 groups (early [0.10 ± 0.02] versus late [0.12 ± 0.03], t-test; P = 0.52). The rates of postoperative glaucoma (P = 0.5) and hemorrhage (P = 0.19) did not differ significantly between the 2 groups.

CONCLUSION

Delaying the repair of primary macula-on retinal detachment by more than 24 hours does not appear to cause worse visual or anatomic outcomes compared with early (<24 hours) surgical intervention. There was no significant difference in the complication rates between the two groups.

Rhegmatogenous retinal detachment

Patients often present after trauma with symptoms of vision loss or loss of a field of vision from a rhegmatogenous retinal detachment (RRD). This study aims to equip the health care provider with knowledge on the recognition, evaluation, and management of RRD to improve communication between the patient and consultant. The article highlights the symptoms, signs (including ophthalmoscopic findings), and pathogenesis of RRD. Causes and presentations of RRD are considered. Treatment paradigms are discussed and surgical options for treatment of RRDs are reviewed, including pneumatic retinopexy, pars plana vitrectomy, and scleral buckle surgery.

[Vitreoretinal outpatient surgery: clinical and financial considerations]

INTRODUCTION

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management.

METHODS

We report on the 6-month experience of outpatient surgery for vitreoretinal diseases.

RESULTS

From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system.

DISCUSSION

Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

The learning curve for primary vitrectomy without scleral buckling for pseudophakic retinal detachment

BACKGROUND

To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in pseudophakic patients and to present the learning curve for this surgery in less experienced surgeons.

METHODS

We reviewed the charts of pseudophakic patients treated with primary vitrectomy without scleral buckling for a rhegmatogenous retinal detachment with PVR<C in two academic centres by four surgeons (two more experienced and two less experienced surgeons) for 1 year. The primary endpoint was the reattachment rate with a single procedure by less experienced and more experienced surgeons. Then, to assess the learning curve of this treatment, we compared the results obtained in consecutive pseudophakic patients by less experienced surgeons at the beginning and after a 2-year training period.

RESULTS

First, 133 patient charts with a minimum follow-up of 6 months were included. Retinal reattachment was achieved with a single surgery in 75.2% for all surgeons. This rate was 80.9% for more experienced surgeons compared to 70% for less experienced surgeons (p = 0.37). In another series of 239 patients operated on by less experienced surgeons, the success rate obtained at the beginning of the training period for less experienced surgeons significantly increased after 2 years (from 66.7% to 80%, p < 0.049).

CONCLUSION

Primary vitrectomy without scleral buckling is an effective procedure to treat pseudophakic retinal detachment. Less experienced surgeons need sufficient time to achieve acceptable success rates, reflecting the learning curve for this procedure.