Survey of Surgical Indications and Results of Primary Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachments☆
Introduction
Although scleral buckling is a well-established surgical procedure for repairing retinal detachment, the manipulation may be complex and difficult if the detachment is associated with large breaks or breaks located posterior to the equator.1, 2 Inadvertent complications may result, such as subretinal hemorrhage, extraocular muscle imbalance,3 corneal contour changes,4, 5, 6 and chorioretinal circulatory disturbances.7 Therefore, scleral buckling appears to have some limitations in achieving early functional recovery.8
To avoid the surgical complications associated with scleral buckling, primary vitrectomy was introduced by Escoffery et al9 in 1985, and later by Ogino et al,10 as an alternative treatment for uncomplicated retinal detachments. However, the surgical results obtained in those pilot studies were not sufficiently superior to those obtained with scleral buckling. Because failed vitrectomy may result in proliferative vitreoretinopathy, primary vitrectomy was still indicated only for unusual or complicated cases, such as retinal detachment with retinal breaks located posterior to the equator or with giant retinal tears.11, 12 For the past decade, however, pars plana vitrectomy has become a well-established technique because of the development of surgical techniques and novel instruments. Several series have been published recently13, 14, 15, 16, 17, 18 that report on primary vitrectomy to treat retinal detachments with the retinal breaks located anterior to the equator. In most of those reports,9, 10, 11, 12, 13, 14, 15, 16, 17, 18 however, because the surgical procedures during vitrectomy, i.e., performing or not performing scleral buckling procedures and removing or sparing the lens, differed among the studies, the surgical results including visual recovery and surgical complications cannot be well evaluated and compared.
In the present study, we report a large series of patients who underwent primary vitrectomy to treat rhegmatogenous retinal detachment. We retrospectively evaluated the surgical results, with particular focus on the necessity of using encircling buckling during vitrectomy and the efficacy of combining vitrectomy and cataract surgery to achieve a high retinal reattachment rate.
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Materials and Methods
A retrospective analysis was carried out of the surgical results in 63 eyes of 63 patients who underwent pars plana vitrectomy as the initial surgical intervention to treat rhegmatogenous retinal detachment at Osaka Rosai Hospital between June 1993 and December 1996. In total, 378 retinal detachment surgeries were performed during the study period and primary vitrectomy was performed in 17% of those surgeries. Of the 63 patients, 62% (39 of 63) were men and 38% (24 of 63) were women. The ages
Surgical Techniques
Table 2 shows the number of eyes that underwent an encircling buckling procedure and combined vitrectomy-cataract surgery. Of the 31 eyes that did not undergo an additional scleral buckling procedure, cataract surgery was combined in 19 eyes (61.3%). In contrast, cataract surgery was performed simultaneously in only 5 of 32 eyes (15.6%), in which encircling buckling also was performed. The mean interval from the onset of symptoms to the initial surgery was 7.9 ± 5.1 days.
Retinal Reattachment Rate
The retinal
Discussion
In the present study, although the sizes and locations of the retinal breaks varied, all were associated with a posterior hyaloid separation. In this series of 63 eyes, the retinal reattachment rate was 92.1% (58 of 63 eyes) after a single surgery and 100% after one or more operations. To the best of our knowledge, no previous studies have reported the use of primary vitrectomy to treat retinal detachments with multiple peripheral retinal breaks. Escoffery et al9 reported a retinal reattachment
Acknowledgements
This paper was previously published in the Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 1998;102:389–394. It appears here in a modified form after the peer review and editing processes of this journal.
Presented in part at the 35th Annual Meeting of the Retinavitreous Society of Japan, Osaka, December 1996.
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The authors have no proprietary interest in any of the materials or equipment discussed in this article.