Primary vitrectomy for rhegmatogenous retinal detachment
Tarun Sharma1993, Graefe's Archive for Clinical and Experimental Ophthalmology
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Abstract
One hundred and twenty-four eyes with a rhegmatogenous retinal detachment, considered to be at high risk of failure if treated conventionally, underwent vitrectomy and internal tamponade, with or without scleral buckling, as the primary procedure. The retina was reattached in 64.5% of eyes after one operation, 75.0% after two, and in 83% of eyes after more than two operations, with no difference in the success rate between those eyes which underwent vitrectomy alone, and those that received adjunctive scleral buckling; duration of surgery was significantly shorter, however, in the former group. Twenty percent of eyes redetached in association with proliferative vitreoretinopathy, and 20% of phakic eyes developed posterior subcapsular lens opacities after surgery. Vitrectomy is now an established method in the management of selected cases of rhegmatogenous retinal detachments.
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Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases
Graefe's Archive for Clinical and Experimental Ophthalmology, 2006
One hundred and twenty-four eyes with a rhegmatogenous retinal detachment, considered to be at high risk of failure if treated conventionally, underwent vitrectomy and internal tamponade, with or without scleral buckling, as the primary procedure. The retina was reattached in 64.5% of eyes after one operation, 75.0% after two, and in 83% of eyes after more than two operations, with no difference in the success rate between those eyes which underwent vitrectomy alone, and those that received adjunctive scleral buckling; duration of surgery was significantly shorter, however, in the former group. Twenty percent of eyes redetached in association with proliferative vitreoretinopathy, and 20% of phakic eyes developed posterior subcapsular lens opacities after surgery. Vitrectomy is now an established method in the management of selected cases of rhegmatogenous retinal detachments.
Primary Vitrectomy without Scleral Buckling for Pseudophakic Rhegmatogenous Retinal Detachment
American Journal of Ophthalmology, 2008
Comparison of outcomes: scleral buckling and pars plana vitrectomy versus vitrectomy alone for primary repair of rhegmatogenous retinal detachment
Clinical ophthalmology (Auckland, N.Z.), 2017
To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs). The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR). Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PP...
Risk factors for failure after primary vitrectomy with no scleral buckling for rhegmatogenous retinal detachment Fatores de risco para falha de tratamento após vitrectomia primária sem retinopexia com introflexão escleral
Revista Brasileira de Oftalmologia , 2023
Objective: To assess pre-operative conditions that could influence primary anatomical success rate in a cohort of patients with rhegmatogenous retinal detachments (RRD) treated with primary vitrectomy and no scleral buckling. Methods: A retrospective analysis was performed in a group of patients that underwent primary pars plana vitrectomy with gas tamponade and without scleral buckling for RRD between 2014 and 2019, with a minimum follow-up of 4 months. Results: 305 eyes of 301 patients were included; 59.01% eyes were phakic, 39.01% were pseudophakic
Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks
Clinical & experimental ophthalmology, 2003
The purpose of the present paper was to compare the techniques of conventional scleral buckling and combined pars plana vitrectomy and scleral buckling procedures in rhegmatogenous retinal detachments with unseen retinal breaks. Forty-four consecutive eyes with uncomplicated, primary rhegmatogenous retinal detachments with a clear media and unseen retinal breaks were randomized to two groups. The scleral buckling group underwent 360 degrees scleral buckling, cryopexy and external subretinal fluid drainage. In the combined surgery group, 360 degrees scleral buckling, pars plana vitrectomy, air-fluid exchange, endolaser and injection of 14% perfluoropropane gas was done. At 3 months follow up the primary reattachment rate was 80% (16/20 cases) in the combined surgery group, and 70% (14/20 cases) in the scleral buckling group (P = 0.716). The visual acuity improved significantly from a preoperative median of hand movement (HM; range: HM to 6/60; similar in both the groups), to a median...
Formation of proliferative vitreoretinopathy in primary rhegmatogenous retinal detachment
Documenta ophthalmologica. Advances in ophthalmology, 2000
Proliferative vitreoretinopathy (PVR) is the only cause of ultimate failure following retinal detachment surgery. This study aimed to review the rate of postoperative PVR in a series of 186 consecutive patients with primary rhegmatogenous retinal detachments. All 186 detachments were repaired with a scleral buckling procedure combined with cryotherapy. Drainage of subretinal fluid was done at the discretion of the surgeon. The mean follow-up was 12 months. In this series 152 (82%) of primary detachments were repaired succesfully with a single operation. Sixty-eight percent of patients regained 0.3 or better visual acuity, and 3% of patients were left with visual acuity of 1/60 or less. After two or more operations the retina was attached in 96% of the cases. In 12 (6%) eyes PVR was responsible for the initial surgical failure. In 4 cases PVR (grade B and limited C) was present prior to surgery. In 3 cases PVR developed within 2 days postoperatively, in 3 cases after 3-6 weeks and in...
Surgical outcomes in rhegmatogenous retinal detachment at Srinagarind Hospital
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
To evaluate the surgical outcome for patients with rhegmatogenous retinal detachment and to find out the factors influencing the anatomic reattachment and visual results. Retrospective review of the medical records of patients for the following details: age, sex, time to diagnosis, time to surgery, phakic status, types, numbers and locations of the retinal breaks, macular status, presence of proliferative vitreoretinopathy (PVR), types of surgical procedures, anatomic reattachment and visual improvement. Two hundred and twelve patients were surgically treated by pneumatic retinopexy, scleral buckling, pars plana vitrectomy or combined procedures. Initial anatomic reattachment was found in 157 cases (74.06%) and final reattachment in 193 cases (91.04%). Several factors including age, phakic status, number of the retinal breaks, macular detachment, PVR and types of surgical procedures have been identified to have a correlation with the anatomic success rate. Types of surgical procedur...
Long-term follow-up of vitrectomy, with or without 360° encircling buckle, for rhegmatogenous retinal detachment due to inferior retinal breaks
Clinical Ophthalmology, 2016
The aim of this study was to report and compare the anatomic and functional results of primary vitrectomy with and without 360° encircling scleral buckle (SB) for the treatment of rhegmatogenous retinal detachment (RRD) due to inferior retinal break(s). Background: A variety of options, including SB, pars plana vitrectomy (PPV) with or without SB, and pneumatic retinopexy have been described as methods to repair RRDs. The use of additional SB with vitrectomy for RRD associated with inferior breaks has been a recent controversy after the introduction of transconjunctival cannula systems. Patients and methods: A retrospective, interventional, comparative case study was performed. In this study, we reviewed 105 consecutive patients who underwent vitrectomy for primary RRD with inferior retinal break(s) at the vitreoretinal center, performed by a single surgeon. Ninety four patients (94 eyes) were followed up for at least 4 months after silicon oil removal (SOR), and were analyzed. They were divided into two groups: group I included 50 patients who underwent PPV alone + silicon oil (SO); and group II included 44 patients who underwent PPV with 360° SB + SO. The essential parameters were single-operation success rate (SOSR) before SOR, incidence of retinal redetachment after SOR, and final visual acuity. Results: SOSR was obtained in 89 eyes (47 [94%] in group I and 42 [95.5%] in group II). From overall 59 phakic retinal detachments (RDs), SOSR was obtained in 56 eyes (30 in group I [93.8%] and 26 in group II [96.3%]) while from overall 35 aphakic or pseudophakic RDs, SOSR was obtained in 33 eyes (17 in group I [94.4%] and 16 in group II [94.1%]). Retinal redetachments after SOR occurred in three patients in group I and two patients in group II. Visual acuity improvement was greater in group I than in group II before SOR. Conclusion: Both surgical procedures had similar reattachment rates. The addition of 360° SB to PPV + SO might not have additional benefits in patients with RD due to inferior retinal break.
Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks
Graefe's Archive for Clinical and Experimental Ophthalmology, 2004
Background: There is controversy about the most appropriate operating methods for complicated rhegmatogenous retinal detachment (RD) including multiple tears, and surgical techniques may be changed according to the preference of the surgeon. In this retrospective study, we compared the surgical results of conventional buckling surgery and vitrectomy with silicone oil tamponade for rhegmatogenous (RD) with multiple breaks. Methods: Thirty patients who underwent scleral buckling surgery (group 1) and 22 patients who underwent pars plana vitrectomy with silicone oil tamponade (group 2) as the primary surgery for rhegmatogenous RD with multiple breaks were included in this study. The follow-up period was longer than 6 months after surgery. The anatomical success rates and complications were evaluated for both groups. Results: Retinal reattachment was
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Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy
BMJ Open Ophthalmology, 2021
Objective To report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD). Methods and analysis Data from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research. Results PPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of t...
Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment (SPR Study): Design issues and implications
Graefe's Archive for Clinical and Experimental Ophthalmology, 2001
Background: In patients with more complex rhegmatogenous retinal detachments (RRD) not complicated by proliferative vitreoretinopathy (PVR), the most appropriate operating method is controversial, and different surgeons use different techniques. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachments Study (SPR Study) is designed to compare primary vitrectomy and scleral buckling techniques in these patients. Methods: The SPR Study is a multicentre, randomised, controlled clinical trial stratified by lens status. Patients with RRD which is not complicated by PVR grade B or C and which cannot be treated with a single meridional sponge are randomised to either scleral buckling or pars plana vitrectomy as first surgical intervention. Four hundred consecutive patients are to be recruited per subtrial (phakic and aphakic/pseudophakic patients), and followed up for 1 year. The primary endpoint (functional outcome) is the change in visual acuity. Secondary endpoints (anatomical outcome) include postoperative PVR, retinal reattachment and the number of reoperations necessary to achieve retinal reattachment. Twenty-seven institutions (49 surgeons) in six European countries have been recruited for participation in the study. Conclusion: The SPR Study is the first randomised prospective clinical trial to compare scleral buckling and primary vitrectomy in patients with RRD. The results of this study should enable vitreoretinal surgeons to improve the surgical therapy of patients with the more complicated manifestations of RRD.
Evolving Surgical Management of Rhegmatogenous Retinal Detachments
Current Surgery Reports, 2015
Recognition of vitreoretinal traction and retinal breaks in the pathogenesis of rhegmatogenous retinal detachment (RRD) by Gonin in 1919 ushered in the era of surgical treatment. Since then multiple treatment strategies including scleral buckling (SB), pars plana vitrectomy (PPV), and pneumatic retinopexy have evolved. While all are effective treatments, much attention has shifted to determining the best treatment for a patient based on factors such as lens status and presence of complicating factors such as choroidal detachments, proliferative vitreoretinopathy, multiple tears, significant hypotony, or presence of giant retinal tears. Thus far the available data suggest that for uncomplicated phakic detachments both PPV and SB are reliable options, though due to cataract formation SB may be favorable in these patients. For pseudophakic RRDs, the data seem to suggest PPV has a higher single operation success rate than SB. Moreover in complicated RRDs, PPV has a more favorable outcome.
Comparison of Pars Plana Vitrectomy With and Without Scleral Buckle for the Repair of Primary Rhegmatogenous Retinal Detachment
American Journal of Ophthalmology, 2011
MICHAEL KINORI, ELAD MOISSEIEV, NADAV SHOSHANY, IDO DIDI FABIAN, ALON SKAAT, ADIEL BARAK, ANAT LOEWENSTEIN, AND JOSEPH MOISSEIEV • PURPOSE: To compare pars plana vitrectomy (PPV) with combined PPV and scleral buckle (SB) for the repair of noncomplex primary rhegmatogenous retinal detachment (RRD
Vitrectomy with and without scleral buckling for retinal detachment
Arquivos Brasileiros De Oftalmologia, 2007
A novel , less-invasive treatment option for rhegmatogenous retinal detachment and vitreoretinal interface pathologies
2013
S cleral buckling is a common surgical procedure for repairing uncomplicated rhegmatogenous retinal detachment (RRD). The basis of therapy is to form a chorioretinal adhesion around the retinal break in conjunction with releasing the vitreoretinal traction force by the use of the scleral buckle, thus preventing access of intravitreal fluid to the subretinal space via retinal breaks.1,2 Although scleral buckling can be indicated for most primary RRDs, it may result in some vision-threatening complications due to the direct depression of the sclera with the buckle and/or the size and location of buckle placement, such as mechanical ocular motility disturbance secondary to an extraocular muscle imbalance, corneal contour changes, and chorioretinal circulatory disturbances.3-5 Because the therapeutic concept of scleral buckling is to bring retina into contact with treated choroid around retinal tears, the sclera itself may not necessarily be involved in the indentation. Based on this id...
Scleral Buckling Versus Sutureless Parsplana Vitrectomy in the Management of Primary Rhegmatogenous Retinal Detachment
Cureus, 2020
The aim of the article is to compare scleral buckle (SB) and primary sutureless pars plana vitrectomy (PPV) without SB in rhegmatogenous retinal detachment (RRD) repair. Methods A retrospective study of rhegmatogenous RD surgeries performed between eyes with proliferative vitreoretinopathy (PVR) up to grade B and a minimum of two months postoperative follow-up were included. The primary outcome measure was an improvement in the final best-corrected visual acuity (BCVA) and secondary outcome measures were a final anatomical success, number of resurgeries, and cataract progression. Results A total of 37 eyes in the SB group and 30 eyes in the sutureless PPV group were included. The mean followup was 7.5 ± 5 months and 9 ± 4 months in the SB and PPV group, respectively. The improvement in the final BCVA from baseline was four lines in the SB group and five lines in the PPV group (p=0.87). The final anatomical success was 97% in SB and 93% in the PPV group. The number of re-surgeries for attachment of retina were higher in the PPV group, (SB: 8/37 vs PPV: 8/30 p=0.03).The number of resurgeries (16/37 vs. 33/30; p=<0.05), cataract progression (3/37 vs. 10/30; p=0.01), and the mean number of hospital visits (6 vs. 9; p=0.001) were significantly higher in the sutureless PPV group. Conclusions Visual acuity improvement and anatomical success rates were similar between SB and sutureless PPV in RRD repair. The number of operations, cataract progression, and the mean number of hospital visits were higher in the sutureless PPV group.
Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment
International journal of ophthalmology, 2012
To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to cl...
Surgical outcomes after pneumatic retinopexy, scleral buckle placement, and/or pars plana vitrectomy in cases of primary rhegmatogenous retinal detachment
2018
Purpose: To investigate the outcomes and success rate of surgical intervention for patients diagnosed with primary rhegmatogenous retinal detachment. We investigate the most common and current procedures: pneumatic retinopexy (PR), pars plana vitrectomy(PPV), scleral buckle(SB), and combined vitrectomy and scleral buckle(SB+PPV). Methods: This nonrandomized, retrospective case series was conducted using data from a single retina surgeon at Beth Israel Deaconess Medical Center. Patient data was collected from September 1999-October 2017. The main inclusion criteria were diagnosis with a primary (meaning it is a first RD experienced by the eye) RRD and subsequent treatment with scleral buckle, vitrectomy, pneumatic retinopexy, or a combination of scleral buckle and vitrectomy (SBV). Patients who have experienced a prior RD, trational RD, or RD due to trauma were excluded from this study. Preoperative and postoperative VA was compared using a logarithm of the minimum angle of resolution (logMAR) score. sixty patients underwent PR treatment (n=60), sixty patients were treated with a combination of SB+PPV (n=60), fifty-two were treated with PPV vii (n=52) alone, and fifty-four had SB (n=54) treatment. A successful outcome was a complete reattachment of the retina in subsequent follow-up appointments based on comprehensive fundus exams and ocular coherence tomography (OCT) scan. Results: Our study showed significant success rates across all four potential surgeries. PR having a success rate of 48/60 (72%), SB+PPV with 53/60 (88%), PPV at 41/52 (77%), and SB showing 41/54 (79%). Starting visual acuity for PR was .67, Combined SB+PPV patients started with 1.4, PPV patients had a 1.84 logMAR score, and SB patients had a starting visual of 1.82. Patients undergoing PR treatment had a lower occurrence of mac-off RRD at 55%. While patients who underwent combined SB+PPV, vitrectomy alone, and SB had higher rates of mac-off RRD at 67%, 60%, and 58% respectively. Conclusions: Our study demonstrated good outcomes for all surgical procedures used. While the type of surgery performed will depend on a case-by-case determination. The results of our study showed improvement in visual acuity in patients after treatment for primary rhegmatogenous retinal detachment (RRD). Overall, the results of our study demonstrate very good outcomes for patients treated with PR, vitrectomy, SB, and
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