Elsevier

Japanese Journal of Ophthalmology

Volume 43, Issue 2, March–April 1999, Pages 120-126
Japanese Journal of Ophthalmology

Survey of Surgical Indications and Results of Primary Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachments

https://doi.org/10.1016/S0021-5155(98)00075-6Get rights and content

Abstract

Background: Several surgical techniques to repair rhegmatogenous retinal detachment have been developed. Recently, both the method of reattaching the retina and of obtaining an early visual recovery are considered important factors when determining which surgical techniques to perform to treat retinal detachment.

Cases: The surgical outcome in a series of 63 consecutive patients, who were treated at Osaka Rosai Hospital between 1993 and 1996, was reviewed retrospectively to evaluate the efficacy of primary vitrectomy to treat uncomplicated rhegmatogenous retinal detachment associated with posterior hyaloid separation. The criteria for vitrectomy included the presence of not only posterior retinal breaks, but also of multiple peripheral retinal breaks.

Observations: The reattachment rate after the first surgery was 92.1% (58 eyes), and by the final examination it increased to 100%. Of the 46 eyes with macular detachment, good visual rehabilitation and a visual acuity improvement of 5 or more lines was obtained in 33 eyes (71.7%) by 1 month postoperatively. No statistically significant difference in the reattachment rate was found when eyes that underwent an encircling procedure were compared with those that did not. In eyes with lens opacity, cataract surgery was also performed and intraocular lenses were implanted uneventfully in all but one case with myopia. There was a high incidence (53.8%) of cataract progression in phakic eyes. However, no other serious complications, such as proliferative vitreoretinopathy, were found throughout the follow-up period.

Conclusions: The results indicate that vitrectomy performed to alleviate peripheral vitreoretinal traction is an effective surgical technique to treat primary rhegmatogenous retinal detachment. Vitrectomy combined with cataract surgery may also be a valuable surgical option in selected cases to maintain long-standing visual rehabilitation.

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.

Section snippets

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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