Surgical outcomes of Pars Plana Vitrectomy for recurrent retinal detachment in eyes previously treated with Pars Plana Vitrectomy or Scleral Buckling

Re-vitrectomy for recurrent retinal detachment in post-vitrectomy eyes of rhegmatogenous retinal detachment

Background

Recurrent retinal detachment (Re-RD) usually affects the prognosis of surgery for rhegmatogenous retinal detachment (RRD). Previous clinical studies of Re-RD were not specific. This study aimed to analyze the clinical characteristics of Re-RD in post-vitrectomy eyes with RRD and surgical outcomes after revitrectomy without combining it with retinectomy or scleral buckling.

Methods

This is a retrospective case series analyzed the ocular characteristics of 20 recurrent and contralateral eyes, evaluated the significance of the associations between variables before reoperation and the final best-corrected visual acuity (BCVA), and calculated the outcome of revitrectomy.

Results

Patients with phakic eyes, those undergoing only one surgery, and those with more than one break had better final BCVA. The final BCVA was negatively correlated with the axial length and positively correlated with the preoperative BCVA. Among the 12 eyes with no break detected before surgery, 11 (92%) were found to have a small crevice-like break beside the pigment scar of a large number of original laser spots. The single-operation complete retinal reattachment rate was 75%, the complete retinal reattachment rate was 80%, and the final incomplete retinal reattachment rate was 90%. The BCVA improved from 1.2 ± 0.6LogMAR (0.06 ± 0.25) before surgery to 0.8 ± 0.7LogMAR (0.15 ± 0.2) at the last follow-up. The BCVA of 16 patients with complete retinal reattachment improved from 1.0 ± 0.5LogMAR (0.1 ± 0.3) to 0.6 ± 0.4LogMAR (0.25 ± 0.4). In the contralateral eyes, 15% already had vision-damaging disease, and the incidence of eyesight-threating lesions was 5.9% during follow-up.

Conclusions

Revitrectomy without retinectomy or scleral buckling can effectively treat Re-RD in post-vitrectomy eyes. In Re-RD patients with no definite retinal break detected preoperatively, the retinal hole usually shows small crevice-like changes alongside a large number of original laser pigment scars.

Surgical outcomes in inferior recurrences of rhegmatogenous retinal detachment

AIM

To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment (RRD) depending on the surgical approach.

METHODS

Eighty-one eyes of 81 patients (47 males and 34 females with a mean age of 54.8±14.1y) who demonstrated at least one inferior recurrence of RRD were included in this retrospective study. All patients were categorized as having received either circular scleral buckling (SB), pars plana vitrectomy (PPV), a combination of SB and PPV (SB+PPV), PPV with retinotomy (PPV+RT), or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade (PPV+RT+pPFCL). All cases were followed up until successful retinal reattachment or third recurrence. The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and best-corrected visual acuity (BCVA).

RESULTS

After the treatment of the first recurrence, the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV (P=0.0012), PPV+RT (P=0.028), or PPV+RT+pPFCL (P=0.047) group. There was no statistically significant difference between PPV+SB, PPV+RT, and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence (42 eyes). However, there was a statistically significant (P=0.016) trend towards a decrease of recurrence rate after PPV+RT+pPFCL. There was no statistically significant improvement of BCVA in either study group (P>0.05) after both first and second recurrence surgery. The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.

CONCLUSION

Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV. RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes, however, without functional improvement.

Outcome of scleral buckling with or without gas tamponade for recurrent retinal detachment in post-vitrectomy eyes

Background

Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once.

Methods

We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed.

Results

The original PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2–5 operations. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160 ± 20/63 at baseline to 20/80 ± 20/50 at the last visit in the 13 successfully treated eyes (P = 0.025).

Conclusions

SB can be effective for re-RD after PPV in specific cases.