Letter to the Editor: Perfluorocarbon-Free Vitrectomy for Rhegmatogenous Retinal Detachment: Feasibility and Outcomes in the Small-Gauges Era

Recurrences and Macular Complications after Perfluorocarbon-Liquid-Free Vitrectomy for Primary Rhegmatogenous Retinal Detachment

INTRODUCTION

This study investigates factors associated with recurrent rhegmatogenous retinal detachment (RRD), macular complications, and visual outcomes after pars plana vitrectomy (PPV) without perfluorocarbon liquids (PFCLs) for primary RRD.

METHODS

A longitudinal cohort study included consecutive patients with RRD who underwent PFCL-free PPV. Postoperative visual acuity and spectral-domain optical coherence tomography findings [cystoid macular edema (CME), epiretinal membrane (ERM), ellipsoid zone/interdigitation zone (EZ/IZ) damage] were collected. Logistic regression and linear mixed models analyzed rates and risk factors for RRD recurrence, CME, ERM, EZ/IZ damage, and visual acuity at 12 months.

RESULTS

346 eyes with RRD were studied. Single-operation success rates were 96% and 93% for uncomplicated (n = 274 eyes) and complicated (n = 72 eyes) RRD, respectively. Factors associated with RRD recurrence were posterior retinal breaks [odds ratio (OR) = 10.7 compared to peripheral retinal breaks, p = 0.008], silicone oil tamponade (OR = 5.66 compared to gas, p = 0.01), and sectorial laser retinopexy (OR = 4.34 compared to 360° laser retinopexy, p = 0.007). The prevalence of CME, ERM, and EZ/IZ damage at 12 months was 10%, 9%, and 6%, respectively. Eyes with EZ/IZ defects had worse postoperative visual acuity in both uncomplicated and complicated RRD. Proliferative vitreoretinopathy (OR = 2.95, p = 0.03) and silicone oil tamponade (OR = 3.70 compared to gas, p = 0.05) were associated with EZ/IZ damage.

CONCLUSIONS

PFCL-free PPV demonstrated satisfactory single-operation success rates for uncomplicated and complicated RRD, with a low prevalence of macular complications. Analyzing factors associated with RRD recurrence can provide provisional recommendations for PFCL-free approaches in the absence of randomized trials.

Vitrectomy for Complicated Retinal Detachment Without the Use of Perfluorocarbon Liquid: A Real-World Data and Retrospective Study

Introduction

This study aimed to evaluate the effectiveness of vitrectomy without using perfluorocarbon liquid (PFCL) for the treatment of complicated retinal detachment (RD).

Methods

The utilisation of PFCL was calculated in four hospitals in 2020 and in one hospital every year from 2012 to 2020. A case series of 320 RD eyes treated with vitrectomy without the use of perfluorocarbon liquid (VWTPL) was followed up for 1–26 months. The rate of retinal reattachment (RR) and postoperative visual acuity (VA, LogMAR) was evaluated. Furthermore, factors influencing RR and VA were analysed.

Results

The overall utilisation of PFCL was 43.87% (42.74%, 45.83%, 62.39% and 4.5%). The annual utilisation was 46.94%, 20.43%, 46.73%, 47.41%, 20%, 17.24%, 7.60%, 10.67% and 4.49% from 2012 to 2020. The VA of 320 eyes improved from 1.96 ± 1.07 preoperatively to 1.43 ± 0.92 (LogMAR, p < 0.001) 1 week post-operation. In the follow-up of 1–26 months (median: 9 months), the primary and final RR was 87.37% and 95.56%, respectively. Age, uveitis, recurrent RD, the number of detached retinal quadrants, aPVR and preoperative VA were considered as the factors influencing postoperative VA. Moreover, preoperative VA and preoperative intraocular pressure were the factors influencing RR.

Conclusion

The utilisation of PFCL varies amongst hospitals with a highest percentage of 62.39%. VWTPL is safe and effective, thereby saving costs and preventing complications related to PFCL.

Trial Registration

ChiCTR-ORC-17014225.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00479-x.

Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.

Macular optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment

The primary aim of this study was to summarize and illustrate the main structural cross-sectional optical coherence tomography findings encountered after vitreoretinal surgery for rhegmatogenous retinal detachment. This was a non-systematic review of literature on structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment. Adequate illustrations of the main findings described were found after a retrospective analysis of imaging and charts of patients operated at the department where this study was performed. The main structural cross-sectional optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment included persistent subretinal fluid, subretinal blebs, retinal folds, subretinal perfluorocarbon liquids, macular alterations related to silicone oil, epiretinal membranes, proliferative vitreoretinopathy, cystoid macular edema, macular holes, and recurrent retinal detachment. In conclusion, optical coherence tomography was a useful tool after vitreoretinal surgery for rhegmatogenous retinal detachment. Some optical coherence tomography findings may not be evident on fundus examination, and optical coherence tomography can reveal essential details for the clinical management and the visual prognosis. Other findings, despite being visible on funduscopic examination, may be better assessed with the aid of optical coherence tomography. All these elements contribute to support the importance of tomographic assessment in the follow-up of eyes treated for vitreoretinal conditions.