Elsevier

Ophthalmology

Volume 106, Issue 9, 1 September 1999, Pages 1811-1816
Ophthalmology

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

Presented in part at the West Coast Retina meeting, February 1994, and the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)90353-6Get rights and content

Abstract

Objective

To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes.

Design

Nonrandomized, prospective, comparative clinical trial.

Participants

Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol.

Intervention

Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months.

Main outcome measures

Reattachment of the retina and visual outcome were compared to previously published studies.

Results

Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was −0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes.

Conclusion

Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.

Section snippets

Patients and methods

Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new primary, rhegmatogenous retinal detachments were referred to Retinal Consultants of Arizona from 1990 through 1997 for a vitrectomy operation to repair the retinal detachment. The procedure was started in 1990 by one of us (R.V.C.) but was stopped in 1992. The surgery and follow-up were completed on the patients by two of us (J.O.S. and S.R.S.). Eyes with grade C or worse proliferative

Results

Two hundred seventy-five pseudophakic eyes (264 patients) with rhegmatogenous retinal detachments were followed for longer than 6 months. Patients were symptomatic for an average of 15 days before their operation. Ninety-seven eyes (35%) had retinal detachments with the macula initially attached while 178 eyes (65%) had retinal detachments where the macula was detached initially (Table 1). Retinal tears were often seen before surgery, but because the visualization of the peripheral retina and

Discussion

We report the results of 275 consecutive pseudophakic eyes with rhegmatogenous retinal detachments that underwent primary PPV to repair the detachments. The main stimulus for the use of this procedure was the disappointing reattachment rate of scleral buckling after one operation2, 4, 5 and the severe anisometropia that resulted from the scleral buckling procedure.13

Of the 97 eyes with macula-attached retinal detachments, 88 (91%) were reattached with 1 operation, and of the 178 eyes with

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Drs. Campo and Flindall are deceased.

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