Scleral buckling and pars plana vitrectomy for rhegmatogenous retinal detachment: an analysis of 542 eyes

Pneumatic retinopexy for primary rhegmatogenous retinal detachment: from a clinical trial to the real-life experience

BACKGROUND

To report real-world outcomes of patients with primary Reghmatogenous Retinal Detachment (RRD) treated with Pneumatic Retinopexy (PnR) according to the indications of the Pneumatic Retinopexy versus Vitrectomy for management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) trial.

METHODS

Multicenter, retrospective study. Patients treated with PnR for RRD between 2021 and 2023 and a follow-up of at least 6 months were included. Single-procedure anatomical success, final anatomical success, complications, causes of failures, best corrected visual acuity (BCVA) after surgery, and the vision-related quality of life using the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were reported.

RESULTS

A total of 76 eyes of 76 patients were included. Mean age was 60 ± 8.1 years. Primary anatomic reattachment was achieved by 84.3% of patients and final anatomical reattachment after pars plana vitrectomy was obtained in 100% of patients. BCVA improved from 0.32 (20/40) to 0.04 (20/20) logMar (p < 0.001) at 6 months. The main cause of failure was related to the presence of additional (likely missed) retinal breaks (66.6% of cases). Also, primary PnR failure was more frequent in eyes of patients with older age, macular involvement, worse baseline BCVA, greater extent of the RRD, and increased duration from diagnosis to treatment. Overall, the mean NEI-VFQ 25 composite score was 93.9% ± 6.4 at 6 months.

CONCLUSIONS

The criteria of the PIVOT trial can be applied to real-world scenarios in the decision-making process for the treatment of primary RRD, with excellent anatomical and functional outcomes.

PNEUMATIC RETINOPEXY: Analysis of Risk Factors and Complications in 850 Cases

BACKGROUND

To study out types and incidence of the complications and reveal the risk factors that affect anatomical and visual success of pneumatic retinopexy with a high number of rhegmatogenous retinal detachment cases.

METHODS

Eight hundred and fifty eyes of the 837 patients who admitted at a tertiary center, between January 2015 and January 2022 for the diagnosis of rhegmatogenous retinal detachment, then underwent pneumatic retinopexy and had at least sixth month follow-up, were included in the study. The multivariate logistic regression model was created to investigate the factors affecting anatomical and visual success.

RESULTS

The anatomical success rate was 53.4% with the first pneumatic retinopexy and 99.8% after subsequent procedures. Visual acuity of >0.4 logMAR (<20/50 Snellen), proliferative vitreoretinopathy, and macular involvement was determined as significant preoperative risk factors for single operation and visual success in all univariate and multivariate analyses. In addition, pseudophakic/aphakic lens status was associated with single operation failure in all analyses. Besides, in all analyzes for single operation and visual success, new or missed tears, proliferative vitreoretinopathy, delayed subretinal fluid, macular hole, and subretinal gas were identified as significant postoperative risk factors. Among these, new or missed tears was determined as the most common complication with a rate of 24%.

CONCLUSION

There are many risk factors influencing the success of pneumatic retinopexy. These factors and complications should always be considered, before applying this rapid, effective, inexpensive, and minimally invasive method.

Risk factors for surgical failure after primary scleral buckling for rhegmatogenous retinal detachment

OBJECTIVE

To identify risk factors for surgical failure after scleral buckling (SB) for primary rhegmatogenous retinal detachment (RRD) repair.

DESIGN

Single-centre retrospective consecutive case series.

PARTICIPANTS

All patients who underwent SB for repair of primary RRD at Wills Eye Hospital between January 1, 2015, and December 31, 2018, were included.

METHODS

Single-surgery anatomic success (SSAS) rate and risk factors associated with surgical failure were evaluated. A multivariable logistic regression model was completed to assess the effect of demographic, clinical, and operative variables on SSAS rate.

RESULTS

A total of 499 eyes of 499 patients were included. Overall SSAS rate was 86% (n = 430 of 499). Using multivariate analysis, surgical failure was more likely in males (adjusted odds ratio [adjusted OR] = 2.98; 95% CI, 1.58-5.62; p = 0.0007) with a macula-off status on preoperative examination (adjusted OR = 2.15; 95% CI, 1.10-4.20; p = 0.03) and preoperative proliferative vitreoretinopathy (adjusted OR = 4.26; 95% CI, 1.10-16.5; p = 0.04). Time interval between initial examination and surgery (p = 0.26), distribution of buckle or band material used (p = 0.88), and distribution of tamponade used (p = 0.74) were not significantly different between eyes with and without surgical failure.

CONCLUSION

Male sex, macula-off status, and preoperative proliferative vitreoretinopathy were factors with increased odds of surgical failure after SB for primary RRD repair. Operative characteristics, such as type of band or use of tamponade, were not associated with surgical failure.

Evaluation of epiretinal membrane formation after scleral buckling for treating rhegmatogenous retinal detachment: En face optical coherence tomography image-based study

PURPOSE

To assess epiretinal membrane (ERM) formation, severity, and the associated risk factors after scleral buckling using en face optical coherence tomography (OCT) images.

METHODS

Medical records of 61 consecutive patients (66 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling were retrospectively reviewed. Posterior vitreous detachment (PVD) was determined based on B-scan OCT images. En face OCT images were used to visualize the ERM and retinal folds. ERM formation was identified by comparing en face images pre- and post-surgery. The maximum depth of the retinal folds (MDRF) was measured using en face imaging to objectively assess traction strength.

RESULTS

ERM formation occurred in 15 (22.7%) eyes at the final visit; the foveal pit was preserved in all cases. Parafoveal retinal folds were present in 5 (7.6%) eyes, with a mean MDRF of 21.8 ± 12.6 µm. No significant difference was observed in best-corrected visual acuity (logarithm of the minimal angle of resolution) between the ERM formation (-0.019 ± 0.128) and non-ERM formation (-0.001 ± 0.213) groups at the final visit (P = 0.593; Mann-Whitney U test). Multivariate logistic regression analysis revealed that older age and the presence of PVD were significant risk factors for ERM formation (odds ratio 1.07, 95% confidence interval 1.01-1.14, P = 0.032; odds ratio 5.26, 95% confidence interval 1.06-26.10, P = 0.042; respectively).

CONCLUSION

ERM occurred in 22.7% of cases but was mild and did not affect visual acuity. Older age and the presence of PVD are risk factors for ERM formation.

Efficacy of pneumatic retinopexy in young adults with rhegmatogenous retinal detachment

Background

In young adults with rhegmatogenous retinal detachment, pneumatic retinopexy can be a cost-effective and minimally invasive highly effective method in suitable cases.

Objectives

To evaluate the role of pneumatic retinopexy in the treatment of young adults with rhegmatogenous retinal detachment (RRD) and the factors that may affect the success of pneumatic retinopexy.

Design

Retrospective study.

Methods

The study included 67 eyes of 67 patients aged between 21 and 40 who underwent pneumatic retinopexy (PR) between January 2015 and June 2021 for primary RRD. We retrospectively analyzed the prognostic factors that may affect the success of PR, such as preoperative age, best corrected visual acuity, tear site, lens condition, and axial length.

Results

PR was successful in 61.2% of the patients, whereas 38.8% required secondary surgery. Between the group that had a single surgery (Group 1) and the group that required secondary surgery (Group 2) the tear location, axial length, and volumes of gases used were statistically different (p = 0.04, p < 0.001, and p = 0.02, respectively). There was a significant difference in visual acuity before and after surgery in the group that was successful with a single surgery (Friedman χ2 = 40.051, p < 0.001). There was no significant difference between the two groups in terms of intraocular pressure (p > 0.05), and glaucoma was not observed in the postoperative period.

Conclusion

Since it is a minimally invasive and cost-effective method that provides rapid visual rehabilitation, it can be considered as first-line therapy in young adults who are suitable for PR.

Advances in biomaterials as a retinal patch for the repair of rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) is the most common retinological emergency that can cause blindness without surgical treatment. RRD occurs when liquefied vitreous accumulates between the neurosensory retina and the retinal pigment epithelium via retinal breaks, which are caused by the separation of the vitreous from the retina with aging. Currently, the main treatment option is pars plana vitrectomy, which involves surgical removal of the vitreous and laser photocoagulation around retinal breaks to generate firm chorioretinal adhesion, as well as subsequent filling of the vitreous cavity with long-lasting substitutes (expansile gas or silocone oil) to prevent the connection between the subretinal space and the vitreous cavity via the breaks before the chorioretinal adhesion firm enough. However, the postoperative face-down position and the not very satisfactory first retinal reattachment rate place a heavy burden on patients. With the development of technology and materials engineering, researchers have developed biomaterials that can be used as a retinal patch to seal retinal breaks and prevent the connection of subretinal space and vitreous cavity via breaks, thus replacing the long-lasting vitreous substitutes and eliminating the postoperative face-down position. Preclinical studies have demonstrated that biomaterial sealants have enough biocompatibility and efficacy in the in vitro and in vivo experiments. Some sealants have been used in clinical trials on a small scale, and the results indicate promising application prospects of the biomaterial sealants as retinal patches in the repair of RRD. Herein, we review the recent advances in biomaterials as retinal patches for the repair of RRD, focusing on the biomaterial categories, methods, and procedures for sealing retinal breaks, as well as their biocompatibility and efficacy, current limitations, and development perspectives.

A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization

Purpose

The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP).

Methods

A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16).

Results

The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0–0.20) in the ID group and 0.08 (0.02–0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94–123) minutes in the ID group and 100 (90–111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100–135) minutes vs 93 (85–111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group.

Conclusion

Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.

Biocompatibility and Efficacy of a Linearly Cross-Linked Sodium Hyaluronic Acid Hydrogel as a Retinal Patch in Rhegmatogenous Retinal Detachment Repairment

To prevent the migration of retinal pigment epithelium (RPE) cells into the vitreous cavity through retinal breaks after the pars plana vitrectomy for the repair of rhegmatogenous retinal detachment (RRD), sealing retinal breaks with an appropriate material appears to be a logical approach. According to a review of ocular experiments or clinical trials, the procedure for covering retinal breaks with adhesives is complex. A commercially available cross-linked sodium hyaluronic acid (HA) hydrogel (Healaflow®) with the injectable property was demonstrated to be a perfect retinal patch in RRD clinical trials by our team. Based on the properties of Healaflow®, a linearly cross-linked sodium HA hydrogel (HA-engineered hydrogel) (Qisheng Biological Preparation Co. Ltd. Shanghai, China) with the injectable property was designed, whose cross-linker and cross-linking method was improved. The purpose of this study is to report the characteristics of an HA-engineered hydrogel using Healaflow® as a reference, and the biocompatibility and efficacy of the HA-engineered hydrogel as a retinal patch in the rabbit RRD model. The HA-engineered hydrogel exhibited similar dynamic viscosity and cohesiveness and G′ compared with Healaflow®. The G′ of the HA-engineered hydrogel varied from 80 to 160 Pa at 2% strain under 25°C, and remained constantly higher than G″ over the range of frequency from 0.1 to 10 Hz. In the animal experiment, clinical examinations, electroretinograms, and histology suggested no adverse effects of the HA-engineered hydrogel on retinal function and morphology, confirming its favorable biocompatibility. Simultaneously, our results demonstrated the efficacy of the HA-engineered hydrogel as a retinal patch in the RRD model of rabbit eyes, which can aid in the complete reattachment of the retina without the need for expansile gas or silicone oil endotamponade. The HA-engineered hydrogel could play the role of an ophthalmologic sealant due to its high viscosity and cohesiveness. This pilot study of a small series of RRD models with a short-term follow-up provides preliminary evidence to support the favorable biocompatibility and efficacy of the HA-engineered hydrogel as a promising retinal patch for sealing retinal breaks in retinal detachment repair. More cases and longer follow-up studies are needed to assess its safety and long-term effects.

Early Structural and Vascular Changes after Within-24 Hours Vitrectomy for Recent Onset Rhegmatogenous Retinal Detachment Treatment: A Pilot Study Comparing Bisected Macula and Not Bisected Macula

Background: In this study we aimed at investigating macular perfusion/anatomical changes in eyes with early onset rhegmatogenous retinal detachment (RRD) after prompt surgery within 24 hours, comparing a bisected macula and not bisected macula RRD. Methods: In this prospective observational study, 14 eyes of 14 patients who underwent within-24 hours vitreoretinal surgery for early onset RRD were enrolled. Patients were further divided into two subgroups: the not bisected macula group (NBM group) and the bisected macula group (BM group). At baseline and 3-month follow up, macular architecture and vessel analysis were assessed using optical coherence tomography angiography (OCTA) imaging. In detail, quantitative and qualitative analyses of the macular area were performed to quantify topographical retinal perfusion changes after surgery, calculating the foveal avascular zone (FAZ), vessel density (VD) and vessel length density (VLD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Most cases (43%) were superotemporal RRD. Primary retinal reattachment was obtained in all cases, without recurrences within 3-month follow up. After surgery, a significant FAZ enlargement was observed at both the SCP and DCP level (p < 0.001; p < 0.05), with a significant effect of time noted between the two time points in the NBM and BM subanalysis (F = 3.68; p < 0.017). An excellent functional outcome was maintained for the whole follow-up. On the other hand, after surgery, perfusion parameters did not change significantly apart from the vessel density of the inferior macular sector at the DCP level (p = 0.03). Conclusions: Our findings suggest that the macular perfusion of eyes with RRD is still preserved if the surgery is performed really promptly, thus highlighting the great importance of a correct timing for surgery. OCTA analysis allows for a better understanding of the pathophysiological mechanisms underneath early vascular microarchitecture modifications of the posterior pole in retinal detachment, differentiating the two types of RRD not completely involving the fovea (BM and NBM).

Pars Plana Vitrectomy versus Scleral Buckle: A Comprehensive Meta-Analysis of 15,947 Eyes

Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P=0.005). SB had a better final BCVA compared to PPV in observational studies (P=0.007) but not in RCTs (P=0.21). SB had a lower incidence of post-operative cataract formation (P<0.00001) and iatrogenic breaks (P<0.00001), but a higher incidence of choroidal hemorrhage (P=0.007), choroidal detachment (P=0.004), and residual subretinal fluid (RSRF) (P<0.00001). Primary (86.5% vs. 84.8%; P=0.13) and final (96.7% vs. 97.7%; P=0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P=0.02) but not in observational studies (P=0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.

Scleral Buckle versus Pars Plana Vitrectomy in the Management of Primary Chronic Rhegmatogenous Retinal Detachment: A Comparison of Anatomical and Visual Outcomes

PURPOSE:

The purpose of this study is to compare the anatomical and visual outcomes of scleral buckle (SB) surgery with the pars plana vitrectomy (PPV) in the management of chronic rhegmatogenous retinal detachment.

METHODS:

This cohort study included patients who underwent surgical repair SB group and PPV group for chronic retinal detachment during 2014–2018 at the King Khalid Eye Specialist Hospital, Riyadh. The anatomical and functional success rate at 12 months after surgery was compared in two groups. Cox regression and linear regression analysis were performed to identify the predictor of anatomical and functional outcomes, respectively. Need for second surgery was also evaluated.

RESULTS:

Our cohort had 68 eyes in SB and 64 eyes in PPV group. Eyes that underwent PPV were more likely to develop retinal detachment over 12 months than those that underwent SB surgery (adjusted heart rates 2.11, 95% confidence interval [CI], 0.95–4.64 P = 0.065). A multivariable linear regression analysis did not reveal a significant association between the surgery type and change in visual acuity (beta coefficient, 0.002; 95% CI,−0.184, 0.189 for specific bread volume; P = 0.979). A higher percentage of eyes in the PPV group compared with those in the SB surgery group required secondary surgery (39.1% vs. 22.1%; P = 0.034).

CONCLUSION:

Scleral buckling surgery showed a better single surgery anatomic success rate as compared to PPV in the management of chronic primary rhegmatogenous retinal detachment. The functional outcome of the two procedures was comparable.

Anatomical outcome of retinal detachment surgery comparing different surgical approach

PURPOSE

To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013.

METHOD

All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal.

RESULTS

In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re-detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach.

CONCLUSIONS

There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.

Metamorphopsia and Morphological Changes in the Macula after Scleral Buckling Surgery for Macula-Off Rhegmatogenous Retinal Detachment

Purpose

To observe the changes in metamorphopsia after scleral buckling (SB) surgery for macula-off rhegmatogenous retinal detachment (RRD) and its association with morphological changes in the macula.

Methods

This prospective study included 20 eyes of 20 patients. Before surgery and 1, 3, 6, and 12 months after surgery, metamorphopsia measured by M-charts and best-corrected visual acuity (BCVA) and macular microstructures assessed using optical coherence tomography were recorded.

Results

Both the vertical and horizontal M-scores improved significantly after SB surgery. BCVA also improved gradually. The mean M-score in the eyes with a continuous external limiting membrane (ELM) was smaller than that in the eyes with a disrupted ELM (P=0.008). Preoperative and postoperative BCVA did not correlate with the mean M-score at any time point. The other studied parameters, namely, the duration of RRD, the height of retinal detachment, central foveal thickness, inner nuclear layer thickness, and continuation of the ellipsoid zone, were also not relevant.

Conclusions

The continuation of the ELM may be a critical factor in determining the severity of metamorphopsia after SB surgery for macula-off RRD.

Pars Plana Vitrectomy Outcomes for Rhegmatogenous Retinal Detachment Qualifying for Pneumatic Retinopexy

Purpose

To investigate real-world outcomes of pars plana vitrectomy (PPV) for eyes with primary rhegmatogenous retinal detachments (RRD) eligible for pneumatic retinopexy (PnR).

Methods

This was a single center retrospective case series looking at consecutive patients with primary RRDs. A database was created on all patients with a primary RRD from 2010 to 2018 based on billing code 67108. Eyes anatomically eligible for PnR were reviewed for preoperative, intraoperative and postoperative characteristics. The main outcome assessed was single surgery anatomical success (SSAS), final anatomical success (FAS), and postoperative LogMAR vision.

Results

A total of 720 eyes (age, 62.9 ± 9.1 years; 61.7% were male) met inclusion criteria for PnR and underwent PPV. SSAS was 94.0% and FAS was 99.9%. Preoperative and final LogMAR vision was 0.853 and 0.293 (P<0.001) in eyes with SSAS vs 0.714 and 0.648 (P=0.686) in eyes with primary failure. PVR was the most common etiology of primary surgical failure (n=21, 49%). Patients who failed primary repair had a mean of 1.12 additional surgeries with a median time of 45 days between surgeries.

Conclusion

A robust single surgery success rate with good visual outcomes was achieved across 8 years and multiple surgeons utilizing PPV to treat primary RRDs in eyes which anatomically qualified for pneumatic retinopexy in a real-world setting.

Scleral buckling versus pars plana vitrectomy in simple phakic macula-on retinal detachment: a propensity score-matched, registry-based study

BACKGROUND/AIMS

To assess the anatomical and visual results of uncomplicated phakic macula-on retinal detachment (RD) in patients treated with pars plana vitrectomy (PPV) or scleral buckling (SB).

METHODS

A retrospective cohort of patients aged <65 years and diagnosed with uncomplicated phakic macula-on primary RD, who were registered in the Japan-Retinal Detachment Registry, was compiled between February 2016 and March 2017. We performed propensity score matching using preoperative findings and surgeon-related factors as covariates to account for relevant confounders. The primary outcome was anatomical failures at 6 months postoperatively, classified as follows: level 1, an inoperable state; level 2, anatomical recovery with silicone oil tamponade; and level 3, need for additional surgery to repair the detachments. The secondary outcome was change in best-corrected visual acuity (BCVA).

RESULTS

Of the 822 included patients, 552 underwent PPV and 270 underwent SB. After propensity score matching, 137 matched cases between the PPV and SB groups were analysed. The total proportion of surgical failures in the PPV group was higher than that in the SB group (risk difference, 0.10 (0.02 to 0.18), p=0.011, McNemar's test). Conversely, the change in BCVA was not significantly different between the two groups (logMAR units, -0.015 (-0.084 to 0.053), p=0.66, paired samples t-test).

CONCLUSIONS

Although the indications for PPV are becoming broader, PPV may not be the optimal approach for repairing all types of RD. Therefore, careful consideration is needed when selecting the right surgical technique for treating uncomplicated phakic macula-on RD cases.

OCT-A in the Management of Vitreoretinal Diseases and Surgery

ABSTRACT

Optical coherence tomography angiography is a relatively new noninvasive technique that is changing our approach in the management of several retinal diseases such as neovascular age-related macular degeneration, occlusive retinal diseases, or diabetic retinopathy, but it could also be useful in nonprimary vascular retinal pathologies such as vitreoretinal interface surgical disorders.In idiopathic vitreoretinal interface disorders and surgical retinal diseases, the study of vascular involvement, not commonly assessed by invasive methods, could be useful to reveal specific vascular abnormalities. Such information may be useful for a more detailed phenotyping of each clinical picture before and after surgical treatment, providing potential new prognostic biomarkers.The review discusses the current and potential utility of optical coherence tomography angiography to study vitreoretinal pathologies of surgical interest.

Internal limiting membrane peel: Does it change the success rate of primary vitrectomy without belt buckle in rhegmatogenous retinal detachments?

Purpose:

To compare the anatomic success of pars plana vitrectomy (PPV) after internal limiting membrane (ILM) peeling at macular area and macular plus peripapillary area versus no peeling in rhegmatogenous retinal detachments (RRD).

Methods:

A prospective observational study between July 2014 and March 2017 conducted on 289 eyes of 287 patients with RRD were randomly assigned to three treatment procedures, viz., PPV with no ILM peeling, PPV with macular peeling, and PPV with macular plus peripapillary peeling. Recurrent RD (ReRD) was treated as an event and accordingly the overall primary (PS) and final success (FS) rates were obtained. The risk of ReRD associated with peeling procedures after adjusting for risk factors were obtained using Cox-proportional hazard analysis.

Results:

The PS percentage for no peel, macular, and macular plus peripapillary procedures were 77.78% (70/90), 82.18% (83/101), and 94.89% (93/98; maximum), respectively, which was statistically significant with a P value of 0.003. The FS percentage for no peel, macular, and macular plus peripapillary were 93.33%, 95.04%, and 100%, respectively, which was significantly different with a P value of 0.048. With reference to no peeling, the adjusted hazard ratio for macular peeling was 0.841 [95% CI: 0.44–1.60] while 0.235 [95% CI: 0.088–0.626] for macular plus peripapillary peeling.

Conclusion:

The anatomic success rate of PPV with macular plus peripapillary ILM peeling was significantly higher as compared to no peel category. The hazard of ReRD in patients undergoing macular plus peripapillary peel was significantly reduced as compared to no peel procedure.

Scleral buckling-a brief historical overview and current indications

The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

Multicenter survey of sutureless 27-gauge vitrectomy for primary rhegmatogenous retinal detachment: a consecutive series of 410 cases

PURPOSE

To evaluate the surgical outcomes of the 27-gauge (G) vitrectomy system for the treatment of primary rhegmatogenous retinal detachment (RRD).

METHODS

This retrospective consecutive series multicenter study involved a total of 410 eyes of 406 patients who underwent 3-port transconjunctival 27G pars plana vitrectomy (PPV) for RRD between November 2014 and December 2016 and who were followed for a minimum of 3 months postoperative. The main outcome measure was primary reattachment, with the secondary outcome measures being final reattachment, improvement of visual acuity (VA), intraocular pressure (IOP), intraoperative and postoperative complications, and surgery time.

RESULTS

Of the 410 treated eyes, primary reattachment was achieved in 392 (95.6%) and final reattachment was achieved in 410 (100%). In 226 eyes (55.1%) with macula-on RRD, the mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.16 ± 0.51 pre-surgery to 0.02 ± 0.14 post-surgery (P = 0.11). In 184 eyes (44.9%) with macula-off RRD, logMAR VA improved from 1.06 ± 0.77 pre-surgery to 0.26 ± 0.35 post-surgery (P < 0.001). Following surgery, the mean IOP was highest at 1 day (15.7 ± 7.0 mmHg) postoperative. In all eyes, surgery was concluded without the use of sutures or the need of conversion to a larger-gauge instrument. Although hypotony was observed in 14 (3.4%) of the 410 treated eyes at 1 day postoperative, it spontaneously resolved within 1 week without additional surgical intervention. No postoperative complications such as infectious endophthalmitis were observed throughout the follow-up period.

CONCLUSION

Our findings show that 27G PPV is both safe and effective for the treatment of primary RRD.

Scleral buckling versus vitrectomy for young japanese patients with rhegmatogenous retinal detachment in the era of microincision surgery: real-world evidence from a multicentre study in Japan

PURPOSE

To evaluate real-world evidence for young Japanese patients with rhegmatogenous retinal detachment (RRD) by retrospectively examining surgical procedures and clinical outcomes in the Japan Clinical Retina Study group.

METHODS

This was a multicentre retrospective study of the medical records of 562 young patients (384 males and 178 females; mean age: 33.0 ± 11.8 years) who had been diagnosed with RRD and who underwent surgical procedures in participating centres during the period between April 2013 and August 2016.

RESULTS

The selected surgeries were scleral buckling (SB) for 295 eyes (49.7%) and pars plana vitrectomy (PPV) for 262 eyes (44.1%). Between the two surgical procedures, there was no significant difference in the primary anatomical reattachment rate (PARR, SB = 92.2%, PPV = 93.9%); improvements in vision were noted in both groups. The incidences of proliferative vitreoretinopathy and cataract formation within 1 year of PPV were 2.3% (p = 0.0047) and 6.5% (p = 0.0005), whereas they were 0% and 1.0% in the SB group, respectively.

CONCLUSION

Scleral buckling (SB) and PPV were chosen with almost equal frequency for young patients with RRD. Clinical outcomes for SB and PPV exhibited a similar PARR. The incidence of cataract formation after PPV may constitute an important limitation of the procedure.

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

PURPOSE

To report anatomical and functional outcomes of pars plana vitrectomy (PPV) for recurrent retinal detachment (RD) after failed scleral buckling (SB) or primary PPV.

METHODS

Retrospective analysis of 59 eyes with recurrent RD treated previously with SB or PPV was performed. All eyes underwent 23 gauge PPV. The primary outcome was single surgery success rate (SSSR) for retinal reattachment at the final visit. Secondary outcomes were visual acuity change and number of reoperations.

RESULTS

SSSR was 77.4 % in the SB group and 67.9 % in the PPV group (P=0.41). The mean change in visual acuity was not significantly different between the two groups (P=0.35). The mean number of reoperations was 1.2±0.5 and 1.4±0.6 in the SB and PPV groups, respectively (P=0.38).

CONCLUSION

PPV was found to be an effective technique for the management of recurrent RD after SB and PPV surgeries. However, the small sample size and the retrospective design prevent any claims of advantages or disadvantages of one surgical technique over the other.

Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment

PURPOSE

To investigate the perioperative clinical factors, which contribute to the postsurgical aqueous flare intensity (AFI) following 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD).

STUDY DESIGN

Retrospective clinical study.

METHODS

We performed retrospective analyses of the medical records of 47 eyes of 47 patients with primary RRD who had undergone 27GPPV with a wide-angle viewing system. AFI was measured preoperatively and 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery.

RESULTS

AFI was significantly increased 1 week after the surgery (p<0.01) and then decreased overtime. At 6 months after surgery it was still statistically significantly higher than preoperative AFI (p=0.03). There was no statistical difference between preoperative AFI and that at 12 months following surgery. Multiple regression analyses revealed that the number of retinal photocoagulations and the performance of scleral indentation had significant positive correlation with AFI at 1 week, 1 month, 3 months, and 6 months, and at 1 month and 3 months after the surgery, respectively.

CONCLUSION

Intraoperative retinal photocoagulation and scleral indentation are probable causes of increased AFI after 27G PPV for RRD.

Advances in the treatment of rhegmatogenous retinal detachment

The pathogenesis of rhegmatogenous retinal detachment depends on three factors, namely, retinal rupture, vitreous liquefaction and traction causing the retina to separate from the pigment epithelium, among which retinal rupture is the most important. Retinopathy is caused by a gap between the neurosensory retina and the retinal pigment epithelium, which severely damages the visual function of the patient. Therefore, early clinical discovery, prevention and selection of an appropriate treatment are important. This article reviews progress in the treatment of retinal detachment.

Effect of Subretinal Fluid Drainage Using Perfluorocarbon During Retinal Detachment Repair on Postoperative Metamorphopsia

BACKGROUND AND OBJECTIVE

To determine whether subretinal fluid drainage (SRF) using perfluorocarbon (PFC) during rhegmatogenous retinal detachment (RRD) repair reduces postoperative metamorphopsia.

PATIENTS AND METHODS

Consecutive patients after RRD were evaluated for best-corrected visual acuity (BCVA), funduscopy, and metamorphopsia using M-CHARTS. Fundus autofluorescence and optical coherence tomography were performed. Clinical and operative data were collected.

RESULTS

The cohort included 30 patients, of whom 11 (36.7%) underwent intraoperative PFC injection. Rates of macula-off RRD were similar in the two groups (54.5% and 47.4%, P = .705). No association was found between PFC injection and metamorphopsia score. Preoperative macula-off RRD was associated with significantly higher vertical and horizontal metamorphopsia scores than preoperative macula-on. BCVA was significantly worse in the patients with metamorphopsia (logMAR 0.15 vs. logMAR 0.04; P = .042) CONCLUSION: Intraoperative SRF drainage with PFC appears to have no beneficial effect on postoperative metamorphopsia. Metamorphopsia is associated with macular status. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e263-e270.].

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

Impact of postoperative positioning on the outcome of pars plana vitrectomy with gas tamponade for primary rhegmatogenous retinal detachment: comparison between supine and prone positioning

PURPOSE

To compare the postoperative anatomic success rates and the frequency of complications between prone or supine postoperative positioning after transconjunctival sutureless vitrectomy (TSV) for rhegmatogenous retinal detachment (RRD).

METHODS

All patients underwent primary 27-gauge TSV for the treatment of primary RRD. Patients were divided into two groups as follows: group A was patients instructed to keep strict postoperative prone positioning for a minimum of 8 days. Group B was patients instructed to keep the prone positioning on the day of the surgery followed by supine positioning for minimum of 7 days from the day after surgery.

RESULT

Sixty-two eyes were enrolled (group A: 32, group B: 30). There was no significant difference in baseline data between two groups. The initial and final anatomical success rates were 93.8% and 100% in group A and 93.3% and 100% in group B, respectively (p = 1, p = 1, respectively). Posterior synechia of the iris occurred in one eye in group A and in two eyes in group B (p = 0.61). Macular pucker and retinal fold did not occur in either group. Preoperative intraocular pressure (IOP; mmHg) was 14.5 ± 2.9 in group A and 14.5 ± 2.6 in group B (p = 0.92). Intraocular pressure (IOP) was not statistically different between the groups during the follow-up period (p = 0.36, p = 0.07, respectively).

CONCLUSION

Supine positioning may be an option as a postoperative positioning after TSV and gas tamponade for the treatment of RRD.

Development of Surgical Management in Primary Rhegmatogenous Retinal Detachment Treatment from 2009 to 2015

PURPOSE

To evaluate the evolution of surgical methods over a 7-year period in patients with primary rhegmatogenous retinal detachment (RRD) and its relation to functional outcome and intra- and postoperative complications.

METHODS

This prospective observational study included 628 patients with primary RRD who underwent surgical repair between January 2009 and December 2015. The main outcome measures were the type of surgical procedure ((scleral buckle (SB), pars plana vitrectomy (PPV), combination of SB and PPV or cryocoagulation (CC)) and intraocular tamponades. In addition, functional outcome and intra/postoperative complications were assessed over the observational period.

RESULTS

During the 7-year observation, the percent of SB procedures decreased from 40.5% in 2009 to 2.7% in 2014, while PPV increased from 38% in 2009 to above 90% in 2014. In 2015, the SB procedure was performed in 10.3% and PPV in 85.6% of patients with RRD (p < 0.001). No consistent trend was observed for the use of intraocular gas tamponade. The functional outcome within the 7-year observation ranged from 0.25 ± 0.31logmar in 2012 to 0.42 ± 0.40logmar in 2009 and showed no statistically significant trend (p = 0.28). Intraoperative complications did not change between 2009 and 2015. The rate of cataract surgery and epiretinal membrane development did not change (p = 0.27; p = 0.09). The percent of re-detachment ranged from 6.2 to 16.5% within the observational period (p = 0.14).

CONCLUSION

A shift toward PPV alone for primary RRD repair was observed during the 7-year observation. No decrease in functional outcome or increase of intra- and postoperative complications or decrease of primary and final anatomic success rate was observed following the change in surgical procedure.

Clinical outcomes of endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment

Summary

We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD). The primary success rate was 98.4% (125/127) without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL) for subretinal fluid drainage.

Purpose

To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD.

Methods

We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated.

Results

Primary and final success rate was 98.4% (125/127) and 100% (127/127), respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (P<0.0001). There were 2 cases (1.6%) of creation of a peripheral drainage retinotomy and 4 cases (3.1%) of using PFCL to suppress movement of the detached retina, but there were no cases of creation of a posterior drainage retinotomy or using PFCL for subretinal fluid drainage. There was 1 case of presumed endophthalmitis after surgery. There were 12 hypotonous cases at postoperative day 1 and one of them needed additional scleral sutures at postoperative day 4 for prolonged hypotony.

Conclusion

The present study demonstrated the efficacy of endoscope-assisted vitrectomy for patients with uncomplicated RRD. To perform endoscope-assisted vitrectomy safely, sufficient closure of sclerotomies is necessary at the end of surgery.

Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series. J Int Med Res 2017;46:316-325. [PMID: 28840752 PMCID: PMC6011313 DOI: 10.1177/0300060517724931]

Objective

To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD).

Methods

Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA).

Results

In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40.

Conclusions

Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

Optical coherence tomography evaluation of patients with macula-off retinal detachment after different postoperative posturing: a randomized pilot study

PURPOSE

To assess the presence of outer and inner retinal folds (RFs) and drop-out of the ellipsoid zone (EZ) occurring after surgical repair of macula-off rhegmatogenous retinal detachment (RRD) with different postoperative posture and preoperative use of adjuvant perfluorocarbon liquid (PFCO).

METHODS

In this prospective study, 56 eyes of 56 consecutive patients affected by RRD were subjected to 23- or 25-gauge pars plana vitrectomy (PPV). The patients were randomized in four groups (14 prone 5 hr without PFCO, 14 supine 5 hr without PFCO, 14 prone 5 hr with PFCO and 14 supine 5 hr with PFCO) and followed up with spectral domain optical coherence tomography (SD-OCT).

RESULTS

Spectral domain optical coherence tomography (SD-OCT) was recorded before surgery, at days 30 and 90 to detect the presence of outer RFs, inner RFs and drop-out of EZ and to follow their variation over time. No statistical significance was found in our groups for outer RFs, inner RFs, drop-out of EZ formation and evolution. The postoperative best-corrected visual acuity (BCVA) improved in all groups (mean preoperative BCVA 1.47 logMar ± 0.19, mean postoperative BCVA 0.27 logMar ± 0.11, p < 0.01), without statistical variations between the four groups in BCVA after surgery.

CONCLUSION

The use of adjuvant and variation in postoperative position did not change the risk of presenting outer RFs, inner RFs and drop-out of EZ after RRD.

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose

The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD).

Methods

The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age.

Results

This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003).

Conclusions

Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD). Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60). Results. This study evaluated 422 eyes of 411 patients with a mean age of 57.7 ± 11.2 years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean = 3.14 ± 1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P = 0.002) and the presence of multiple tears (P = 0.01). Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

Scleral buckling for primary rhegmatogenous retinal detachment using noncontact wide-angle viewing system with a cannula-based 25 G chandelier endoilluminator

Purpose

The aim of this study is to report the result of scleral buckling (SB) using a combination of a noncontact wide-angle viewing system and a cannula-based 25 G chandelier endoilluminator.

Methods

Retrospective analyses of the medical records of 79 eyes of 79 patients with primary uncomplicated rhegmatogenous retinal detachments who had underwent SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator were performed.

Results

There were 50 men and 29 women. The mean ± standard deviation age was 43.7±16.0 years. Their preoperative best-corrected visual acuity (BCVA) was 0.31±0.65 logMAR units. The final BCVA was 0.10±0.31 logMAR units, which was significantly better than the preoperative BCVA (P<0.01). The initial and final anatomical success rates were 92.4% and 100%, respectively. Backward logistic multiple regression analysis revealed no relationship between explanatory variables and the primary anatomic success (P=0.104).

Conclusion

SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator is a modified new technique and may be a valid option for the management of rhegmatogenous retinal detachments.

Comparison of scleral buckling and vitrectomy using wide angle viewing system for rhegmatogenous retinal detachment in patients older than 35 years

Background

To compare scleral buckling (SB) and pars plana vitrectomy (PPV) using a wide angle viewing system (WAVS) for uncomplicated phakic rhegmatogenous retinal detachment (RRD).

Methods

The medical records of patients with uncomplicated phakic RRD were retrospectively reviewed. Eyes with pseudophakic or attached fovea were excluded. Patients treated with SB were classified as group B, and PPV using WAVS as group V. Primary success rate, visual acuity (VA), macular complications, and sustained subretinal fluid (SRF) were compared between groups.

Results

Seventy-two eyes were included in group B and 57 eyes in group V. Group B had better preoperative VA (1.38 ± 0.87 vs 1.84 ± 0.97 in LogMAR, P = 0.010), but worse final VA (0.51 ± 0.48 vs 0.30 ± 0.23, P = 0.012) than group V. The primary success rate of 94.7 % in group V was higher than 77.8 % in group B (P = 0.010). Final success rate was 100 % in both groups. There was no significant difference in macular complications between groups (P = 0.087). Sustained SRF was found in 22 eyes in group B (38.6 %), while only two eyes in group V exhibited sustained SRF (2.8 %, P < 0.001).

Conclusions

Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Pneumatic retinopexy for primary repair of rhegmatogenous retinal detachments

PURPOSE

To evaluate anatomical and functional outcomes of pneumatic retinopexy (PR) for primary repair of rhegmatogenous retinal detachments and to determine demographic and ocular risk factors for failure of the procedure.

DESIGN

Retrospective interventional case series.

METHODS

A chart review on 97 eyes of 97 consecutive patients who had undergone PR as the initial procedure for unilateral recent primary retinal detachments with causative break(s) in the superior two-third of the retina. After injection of 0.35 mL to 0.60 mL of sulfur hexafluoride, 6 hours face-down positioning, and the steamroller maneuver, the patient's head position was changed so that the gas could efficiently tamponade the retinal break(s). Pre- and post-gas injection laser photocoagulation of break(s) and 360° peripheral retina was applied.

RESULTS

Seventy-two male and 25 female patients were included in this study. The single-operation success rate was 82.5%. The pars plana vitrectomy procedure as the second intervention was not adversely affected by the preceding PR. Presence of proliferative vitreoretinopathy (odds ratio: 58.7, 95% confidence interval: 7.8-443.5) and delay between initial symptoms and PR (odds ratio: 1.21 per each additional day, 95% confidence interval: 1.07-1.37) were the only independent predictors for the failure.

CONCLUSION

With proper selection of cases, PR is a good surgical option for primary rhegmatogenous retinal detachments with acceptable success rate, minimal discomfort to the patient, and minimal surgical risks.

Surgical complications of primary rhegmatogenous retinal detachment: a meta-analysis

BACKGROUND

To investigate the surgical complications of scleral buckling (SB) and pars plana vitrectomy (PPV) performed on primary rhegmatogenous retinal detachment (RRD) and to discover which surgical procedures bring fewer complications.

METHODS

An electronic literature search using the PubMed database, ISI Web of Knowledge and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and observational studies comparing SB with PPV on primary RRD. Outcome measures included intra-operative complications and early and late post-operative complications.

RESULTS

During the operation, significantly less subretinal hemorrhage occurred in the PPV group than in the SB group (OR = 4.71; 95%CI, 1.33-16.64; p = 0.02) and the hypotony incidence was significantly higher in the SB group (OR = 18.24; 95%CI, 2.37-140.44; p = 0.005); however, the occurrence of iatrogenic breaks was significantly lower in the SB group (OR = 0.05; 95%CI, 0.01-0.21; p<0.0001). In the early stage of post-operation, significantly higher incidence of choroidal detachment was identified in the SB group than in the PPV group (OR = 10.19; 95%CI, 2.36-44.09; p = 0.002); patients undergoing SB had significantly higher odds of residual subretinal fluid (OR = 14.71; 95%CI, 1.84-117.32; p = 0.01); the occurrence of high intraocular pressure was significantly lower in the SB group (OR = 0.46; 95%CI, 0.23-0.89; p = 0.02); and no significant difference was shown in the incidence of epithelia defect (p = 0.37) between the two groups. In the late stage of post-operation, the incidence of diplopia/extraocular muscle dysfunction was significantly higher in the SB group (OR = 4.04; 95%CI, 1.30-12.52; p = 0.02); and significantly less cataract was observed in the SB group (OR = 0.20; 95%CI, 0.14-0.30; p<0.00001); no significant difference was found in the incidences of cystoid macular edema (p = 0.65), macular pucker (p = 0.52), post-operative proliferative vitreoretinopathy (p = 0.73) and epiretinal membrane (p = 0.47) in other late post-operative complications.

CONCLUSIONS

This meta-analysis suggests that PPV could be considered as potential surgical management on primary RRD.