View 2: The case for primary vitrectomy
- The SPR Study group*
The term “primary vitrectomy for rhegmatogenous retinal detachment” implies that pars plana vitrectomy is the first surgical intervention in the treatment of this disease. In the literature, however, its definition is frequently widened: it often includes patients with rhegmatogenous retinal detachment (RRD) who have undergone either cryotherapy or photocoagulation for retinal breaks or small detachments before vitrectomy, although, strictly speaking, pars plana primary vitrectomy (PPPV) is not the first surgical intervention in these cases. The following assessment is based on the analysis of 25 publications of primary vitrectomy listed in Table 1.
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Reports of primary vitrectomy for the treatment of rhegmatogenous retinal detachment
ADVANTAGES OF PRIMARY VITRECTOMY
The removal of opacities in the vitreous and of capsular remnants or synechia are clear advantages of PPPV. The better intraoperative control of PPPV is supported by the high rates of intraoperative reattachment, even in very difficult cases, achieved by internal drainage and endotamponade. This is further emphasised by the low rate of intraoperative complications, the most frequently observed being iatrogenic breaks (6% of cases in series reporting this complication), and that of lens damage in phakic eyes in 3%. Surgeons nowadays have become more familiar with this technique compared to scleral buckling surgery, as the indications for vitrectomy and the total number of cases outside retinal detachment surgery have increased immensely during the past decade. Further, endoillumination, indentation, a higher magnification, wide angle viewing systems, the removal of opacities, membranes, and the unfolding of detached retina with perfluorocarbon liquids enable a better view of the pathological anatomy and an improvement in the identification of previously unseen breaks, as documented in 77 of 87 cases of previously unseen breaks. The problems associated with external drainage, such as choroidal haemorrhage, retinal incarceration, and retinal perforation, as well as that of scleral perforation during suturing of the exoplant (if …
