Minimally interface vitrectomy for rhegmatogenous retinal detachment with a single break in young patients

Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study

OBJECTIVE

To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy.

METHODS

Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months.

RESULTS

Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p = 0.02).

CONCLUSIONS

Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.

Two-Port “Dry Vitrectomy” as a New Surgical Technique for Rhegmatogenous Retinal Detachment: Focus on Macula-on Results

We evaluated a new surgical technique for treating primary rhegmatogenous retinal detachment (RRD), consisting of localized vitrectomy near the retinal break associated with drainage of subretinal fluid without infusion. Twelve eyes of twelve patients with primary RRDs with macula-on superior, temporal, and/or nasal quadrants’ RRD with retinal breaks between 8 and 4 o’clock, pseudophakic or phakic eyes, were enrolled. All eyes underwent a two-port 25-gauge vitrectomy with localized removal of the vitreous surrounding the retinal break(s), followed by a 20% SF6 injection and cryopexy. The difference between pre-operative (T0) and post-operative mean BCVA at 6 months follow-up (T6) was not statistically significant (0.16 logMAR vs. 0.21 logMAR; p = 0.055). Primary anatomic success at 6 months was achieved by 86% of patients. No other complications, except for two retinal re-detachments linked to an incorrect head position of the patients, were recorded. Although further studies are necessary to evaluate the treatment’s efficacy, we believe our technique could be considered a valid alternative for managing primary RRD.

Cryotherapy versus Laser Does Not Influence Anatomical Success following Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair: Registry Analysis of 2413 Patients

PURPOSE

To determine if a difference exists between cryotherapy and endolaser photocoagulation retinopexy in the rates of anatomical success following primary rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV).

DESIGN

Registry-based, non-randomized, observational cohort study.

SUBJECTS

Eyes with primary RRD in a bi-national retinal surgery registry who underwent repair with PPV and had a minimum of 3-months follow-up.

METHODS

Cases were recorded prospectively by participating surgeons, and outcome was entered at 3 months. A generalized mixed model approach was used to compare the effect of retinopexy type on outcome. Variables known to be associated with retinal surgical success were considered as covariates for the final model. Eyes were divided into two groups: Cryo group (receiving cryotherapy as the only form of retinopexy) and Laser group (receiving endolaser as the only form of retinopexy).

MAIN OUTCOME MEASURES

The primary endpoint was the proportion of patients with stable retinal re-attachment without the need for further retinal detachment surgery, assessed 3-months post-operatively. Failure was defined as either retinal re-detachment, or foveal attachment with long-term silicone oil tamponade at endpoint. The secondary outcome measured was visual acuity at 3-months compared with baseline measurements.

RESULTS

Of a total 2413 patients included, the overall single-procedure success rate was 85%. There was no statistically significant difference in surgical success between the adjusted proportion of successful reattachment for the Cryo group (87%) when compared to the Laser group (82%) (p = 0.84, OR 1.04, 95% CI 0.74, 1.46). There was no difference between groups for the mean change in visual outcomes at 3-months (adjusted mean change of -0.48 logMAR for Cryo vs. -0.50 logMAR for Laser group, p=0.82).

CONCLUSIONS

Choice of cryotherapy versus endolaser retinopexy was not observed to influence the anatomical success of PPV for RRD, nor visual acuity outcomes at 3-months post-operatively.