Retinotomy with retinal turnover to remove subretinal membranes under direct visualization for proliferative vitreoretinopathy

TRANSSCLERAL INCISION FOR PEELING SUBRETINAL PROLIFERATION TISSUE IN GRADE C PROLIFERATIVE VITREORETINOPATHY

PURPOSE

The purpose of this study was to investigate the clinical outcomes of an optimized method to clearly remove the subretinal proliferative tissue by transscleral puncture into the subretinal space in patients with grade C proliferative vitreoretinopathy without inducing retinal injury.

METHODS

This was a prospective clinical observation study. Eight consecutive patients who had undergone optimized vitrectomy surgery for retinal detachment complicated by grade C proliferative vitreoretinopathy were investigated. Subretinal proliferation was cleared by adding one additional scleral 23-gauge trocar under the detached retina at 9 mm to 10 mm from the limbus. After the sclera is pierced, the puncture knife changed its direction without touching the retina. 23-G intraocular forceps were used to remove the proliferation strand or membrane through the puncture channel.

RESULTS

Retinal reattachment was achieved in each case without a retinotomy. The mean best-corrected visual acuity was improved within the first 1 month ( P = 0.039) and remained stable at the following phase. There were no postoperative complications, such as reoccurrence of retinal detachment or proliferative vitreoretinopathy. No postoperative hemorrhage or hypotension was observed.

CONCLUSION

The satisfying results demonstrated the feasibility of this cost-effective, easy-to-follow, transscleral vitrectomy method in treating retinal detachment with grade C proliferative vitreoretinopathy.

Retinotomy and retinectomy in the management of rhegmatogenous retinal detachment associated with advanced proliferative vitreoretinopathy

Purpose:

To report the anatomical and functional outcomes of retinotomy and/or retinectomy for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR).

Methods:

In this retrospective study, the charts of patients who underwent pars plana vitrectomy with retinotomy and/or retinectomy for the management of RRD complicated by PVR were reviewed. Primary outcome measures were final best-corrected visual acuity (BCVA) and anatomical reattachment rate.

Results:

Sixty-one eyes of 61 patients with a mean age of 48.56 ± 15.92 were studied. The mean follow-up time was 21.38 ± 23.08 months. The mean angle of the retinotomy was 171.31° ± 79.15°. Thirty-two (52.5%) of them needed extensive (≥180°) retinotomy. In addition, simultaneous retinectomy was performed in 36.2% of the cases. The BCVA was 2.18 ± 0.63 and 1.85 ± 0.71 logMAR before the surgery and at the last visit, respectively (P = 0.001). The initial anatomical success was achieved in 45 eyes (73.8%) after retinotomy surgery. Sixteen eyes (26.2%) had recurrent RD and needed reoperation, which was performed 5.60 ± 4.01 months after the initial retinotomy surgery. At the last examination, the retina was attached in all patients.

Conclusion:

Retinotomy with/without retinectomy is an effective procedure in the majority of patients with RRD associated with advanced PVR; however, additional surgeries are needed in a significant number of eyes to achieve final anatomical success.

Anatomical and functional outcomes of retinectomies in retinal detachments complicated by proliferative vitreoretinopathy

PURPOSE

To study anatomical and functional outcomes of retinectomies in rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy.

METHODS

This is a retrospective interventional consecutive case series of eyes with rhegmatogenous retinal detachments complicated by advanced proliferative vitreoretinopathy and managed by relaxing retinectomy over a period of seventeen years. Three-port pars plana vitrectomy included core vitrectomy and removal of all epi-retinal membranes. On failure to flatten, retina was cut and excised. Basal vitrectomy and removal of anterior flap of retina then followed. Silicone oil was used as temponade in majority of cases. The dependent variables were anatomical and functional outcomes. The statistical analysis was performed on SPSS 21.

RESULTS

Series included 370 eyes of 337 patients. Mean follow up was 39 months. Scleral explant was used in 90(24.39%) cases. Two hundred and nine (56.49%) eyes were operated with trans conjunctival sutureless vitrectomy technique. Procedure was bilateral in 33 patients (09.79%). Retina attached in 311(84.05%) eyes after initial surgery. Final re-attachment after one or more surgeries was achieved in 344(92.97%) eyes. Two hundred and eleven (57.02%) cases achieved visual acuity of 6/60 or better.

CONCLUSION

Relaxing retinectomies have good and encouraging anatomical and functional outcomes. This surgery can be effectively carried out with trans conjunctival sutureless vitrectomy technique.