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Bellucci C, Romano A, Ramanzini F, Tedesco SA, Gandolfi S, Mora P. Pars Plana Vitrectomy Alone or Combined with Phacoemulsification to Treat Rhegmatogenous Retinal Detachment: A Systematic Review of the Recent Literature. J Clin Med 2023; 12:5021. [PMID: 37568424 PMCID: PMC10420090 DOI: 10.3390/jcm12155021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Pars plana vitrectomy is today a common first-line procedure for treatment of rhegmatogenous retinal detachment (RRD). Removal or preservation of the natural lens at the time of vitrectomy is associated with both advantages and disadvantages. The combination of cataract extraction (i.e., phacoemulsification) with pars plana vitrectomy (PPVc) enhances visualization of the peripheral retina and the surgical management of the vitreous base. However, PPVc prolongs the surgical time and is associated with iatrogenic loss of the accommodation function in younger patients, possible postoperative anisometropia, and unexpected refractive results. Performance of pars plana vitrectomy alone (PPVa) requires good technical skills to minimize the risk of lens damage, and quickens cataract development. We retrieved all recent papers that directly compared PPVc and PPVa using parameters that we consider essential when choosing between the two procedures (the success rate of anatomical RRD repair, postoperative refractive error, intra- and postoperative complications, and costs). PPVa and PPVc were generally comparable in terms of RRD anatomical repair. PPVc was associated with fewer intraoperative, but more postoperative, complications. Macula-off RRD PPVc treatment was often associated with undesirable myopic refractive error. PPVa followed by phacoemulsification was the most expensive procedure.
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Affiliation(s)
| | | | | | | | | | - Paolo Mora
- Ophthalmology Unit, University Hospital of Parma, 43126 Parma, Italy
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Mirshahi A, Khalilipour E, Faghihi H, Riazi-Esfahani H, Mirshahi R, Mehrjardi HZ, Najibzadeh E, Amini A, Nabavi A. Pars plana vitrectomy combined with phacoemulsification versus pars plana vitrectomy only for treatment of phakic rhegmatogenous retinal detachment: a systematic review and meta-analysis. Int Ophthalmol 2023; 43:697-706. [PMID: 35986229 DOI: 10.1007/s10792-022-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD). METHODS Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error. RESULTS Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95-1.10; P = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00-0.12; P = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5-5.41; P = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = -0.31; 95% CI -0.55--0.07; P = 0.01). CONCLUSION There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.
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Affiliation(s)
- Ahmad Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalilipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Romina Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Z Mehrjardi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Najibzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdulrahim Amini
- Department of Ophthalmology, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Nabavi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, Guilan University of Medical Sciences, 17th Shahrivar St, Rasht, Iran.
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Mahmoudzadeh R, Mokhashi N, Anderson H, Patel S, Salabati M, Chiang A, Kuriyan AE, Gupta OP, Mehta S, Garg SJ, Hsu J. Outcomes of Retinectomy without Lensectomy in Rhegmatogenous Retinal Detachments with Proliferative Vitreoretinopathy. Ophthalmol Retina 2023; 7:52-58. [PMID: 35940476 DOI: 10.1016/j.oret.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To report the anatomic and functional outcomes of retinectomy without lensectomy in eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR). DESIGN Retrospective, noncomparative, and interventional case series. SUBJECTS One hundred twelve eyes of 112 patients with RRD complicated by PVR who underwent retinectomy without lensectomy. METHODS Retrospective review of patients treated with vitrectomy and retinectomy without lensectomy from January 1, 2015, to January 1, 2020. MAIN OUTCOME MEASURES The primary outcome was the final attachment rate and single surgery anatomic success (SSAS) at 3 and 6 months after retinectomy. Secondary outcomes included predictors of final visual acuity (VA), the mean number of subsequent operations required for complete retinal reattachment, cataract surgery, and the number of eyes that ultimately had successful silicone oil removal. RESULTS Complete final retinal reattachment was achieved in 111 of 112 (99.1%) patients, with a mean (standard deviation [SD]) follow-up of 29 (14) months (range, 8-62 months) after retinectomy. The SSAS was achieved in 84 of 112 (75%) patients at 3 months and 73 of 112 (65.2%) patients at 6 months. The final VA improved or stabilized in 76 of 112 (67.9%) eyes. Silicone oil removal was performed in 72 of 112 patients (64.3%) at a mean (SD) of 6.6 (3.3) months, and cataract surgery was performed on 101 (90.2%) eyes before the last follow-up visit. CONCLUSIONS Retinectomy without lensectomy to repair RRDs complicated by PVR showed acceptable anatomic and functional results. This study suggests that removing the lens when there is no significant cataract may not be necessary in these cases to obtain reasonable outcomes.
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Affiliation(s)
- Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Nikita Mokhashi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hannah Anderson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shail Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mirataollah Salabati
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen Chiang
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay E Kuriyan
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omesh P Gupta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sonia Mehta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Bellucci C, Benatti L, Rossi M, Tedesco SA, Carta A, Calzetti G, Gandolfi S, Mora P. Cataract progression following lens-sparing pars plana vitrectomy for rhegmatogenous retinal detachment. Sci Rep 2022; 12:22064. [PMID: 36543919 PMCID: PMC9772327 DOI: 10.1038/s41598-022-26415-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Lens-sparing pars plana vitrectomy (PPV) is often followed by cataract development. However, there have been few prospective studies evaluating the timing of cataract progression and potential associated factors. This was an observational study conducted at the Ophthalmology Unit of the University Hospital of Parma (Parma, Italy). Patients presenting with rhegmatogenous retinal detachment (RRD), who underwent PPV with preservation of the lens, were examined according to a scheduled follow-up (3, 6 and 12 months after PPV) and then preoperatively when cataract extraction surgery (CES) was indicated, or at the end of the study follow-up period (May 2021). The primary outcome was the interval between PPV and CES indication (based on predefined refractive criteria). A total of 36 eyes of 36 patients (mean age: 52 ± 10 years) were included in the study. Nineteen eyes (53%) were indicated for CES a median of 14.5 months (IQR: 12.0-24.8) after PPV. The nuclear and posterior subcapsular forms of cataract progressed significantly starting at 6 months after PPV. Older age at the time of PPV, silicone oil tamponade and RRD without macular involvement were significantly and independently associated with an earlier indication for CES. Patient age and the use of silicone oil tamponade must be taken into consideration when evaluating the risk of cataract development after PPV.
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Affiliation(s)
- Carlo Bellucci
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy
| | - Lucia Benatti
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy
| | - Maurizio Rossi
- grid.411482.aDepartment of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | | | - Arturo Carta
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy
| | - Giacomo Calzetti
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy ,grid.508836.0Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland ,grid.410567.1Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
| | - Stefano Gandolfi
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy
| | - Paolo Mora
- grid.411482.aOphthalmology Unit, University Hospital of Parma, Parma, Italy
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Kilian R, Crincoli E, Rizzo C, Ripa M, Faraldi F, Lavia C, Tartaro R, Ceruti P, Casini G, Rizzo S, Savastano A. Refractive error after combined phaco-vitrectomy: A multicentric study. Eur J Ophthalmol 2022; 33:11206721221143165. [PMID: 36503334 DOI: 10.1177/11206721221143165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To study the post-operative refractive error (RE) of patients undergoing combined phaco-vitrectomy and to find out which intraocular lens (IOL)-power formula had the best refractive outcomes. METHODS In this retrospective multicentric study we compared the preoperative expected target with the postoperative RE of patients undergoing combined phaco-vitrectomy due to vitreomacular traction, macular pucker, full thickness macular hole or lamellar macular hole. A multinomial logistic regression was performed to compare the postoperative REs and the differences between expected and postoperative REs among the SRK-T, Olsen's and Holladay-2 formulas. The correlation between the difference in REs and IOL-power was also studied. RESULTS Sixty-seven eyes with a mean axial length of 23.73 ± 1.21 mm were included. Forty-two (63%), 14 (21%) and 11 (16%) eyes were implanted with an IOL that was calculated respectively with SRK-T, Olsen's and the Holladay-2 formula. The mean preoperative expected- and post-operative REs were -0.16 ± 0.12D and -0.48 ± 0.17, respectively (p = 0.045). SRK-T and Holladay-2 formulas led to a significant myopic shift whereas Olsen's caused a significant hyperopic error, independently from the IOL power. CONCLUSION Independently from the IOL power, none of the analyzed formulas is precise at calculating the post-operative RE.
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Affiliation(s)
- Raphael Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Ripa
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | | | - Carlo Lavia
- Surgical Department, Ophthalmology Service, Azienda Sanitaria Locale TO5, Chieri, Italy
| | - Ruggero Tartaro
- Department of NEUROFARBA, Ophthalmology, University of Florence, Careggi, Florence, Italy
| | - Piero Ceruti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giamberto Casini
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Emergency, University of Pisa, Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
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Radeck V, Helbig H, Maerker D, Gamulescu MA, Prahs P, Barth T. Rhegmatogenous retinal detachment repair-does age, sex, and lens status make a difference? Graefes Arch Clin Exp Ophthalmol 2022; 260:3197-3204. [PMID: 35501490 PMCID: PMC9477924 DOI: 10.1007/s00417-022-05674-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/28/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze the correlation between lens status, age, and sex in the epidemiology and success rates of rhegmatogenous retinal detachment (RRD) surgery. METHODS The files of all consecutive patients undergoing vitreoretinal surgery for uncomplicated RRD between Jan 2005 und Dec 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment occurring within 3 months after surgery. RESULTS 5502 eyes with uncomplicated primary RRD were included. Mean age of the patients was 61.1 years (± 13.6 SD). In the age group over 40 years, a male predominance was found. The percentage of pseudophakic RRD increased from 25 to 40% during the 15 years observation period. In the age group 50 to 69 years, patients with pseudophakic detachments were male in 786 out of 1079 cases (72.9%). In the same age group, 1285 of 2110 (60.9%) patients with phakic RRD were male. Overall, primary success rate after one procedure was 91.2% (5018 of 5502). In the phakic eyes, the primary success rate was higher in those eyes that underwent combined phacovitrectomy (93.0%), compared to those without simultaneous cataract surgery (88.7%; p = 0.002). CONCLUSION The ratio of male and female patients with RRD varies between age groups. The proportion of pseudophakic RRD has increased within 15 years. The male predominance in RRD is stronger in pseudophakic than in phakic eyes. In phakic eyes with RRD, a combined phacovitrectomy yielded better anatomical results.
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Affiliation(s)
- Viola Radeck
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany.
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - David Maerker
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
| | - Teresa Barth
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042, Regensburg, Germany
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Vitrectomy Combined with Cataract Surgery for Retinal Detachment Using a Three-Dimensional Viewing System. J Clin Med 2022; 11:jcm11071788. [PMID: 35407397 PMCID: PMC8999361 DOI: 10.3390/jcm11071788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). Methods: Medical reports of 82 patients were retrospectively reviewed: 26 patients were operated on with 3D and 56 patients were operated on with CM. The main outcome measures were visual acuity, duration of the surgery, and the rate of postoperative complications. Results: No statistically significant differences in pre- and postoperative visual acuity were found between both groups. There was significant improvement in the visual acuity in both groups. The best postoperative visual acuity was achieved with SF6 gas tamponade, followed by C3F8 gas and silicone oil in both groups. The duration of the surgery (60 min vs. 55 min) and the rate of postoperative complications (15% vs. 14%) were similar in both groups. Conclusions: The similar postoperative visual acuity and rate of complications detected using 3D and CM indicate that the 3D viewing system may be advantageous in the treatment of rhematogenous RD with PPV combined with cataract surgery, i.e., a complex procedure involving both anterior and posterior segment manipulations.
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