To identify prognostic factors for visual acuity and anatomic outcomes associated with bullous rhegmatogenous retinal detachment (RRD) management using primary pars plana vitrectomy, intraoperative perfluorocarbon liquids (PFCLs), and internal gas tamponade.
Methods
The authors studied a consecutive series of 115 eyes (115 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, and/or posterior breaks in 58 (50.4%) eyes. All eyes underwent vitrectomy, injection of PFCL, and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. The follow-up period ranged from 3 to 60 months (mean 16.6±14.1 months).
Results
Retinal reattachment was achieved in 92.2% of eyes (106/115) with one operation and in all eyes after a second procedure. PVR was observed in 1 (0.87%) eye and pre-retinal membranes in 3 (2.6%) eyes. Progression of pre-existing cataract and development of new cataract occurred in 45 (58.4%) of the 77 phakic eyes. The presence of inferior retinal breaks was significantly associated with redetachment after the first procedure (p=0.0156). On univariate analysis, better preoperative visual acuity (p<0.001), macular sparing retinal detachment (p<0.001), and fewer quadrants involved by the detachment (p=0.0015) were significant positive prognostic factors for final visual acuity. Logistic regression analysis highlighted that macular sparing retinal detachment and absence of trauma were associated with better final visual acuity.
Conclusions
Redetachment was associated with the presence of inferior retinal breaks. Visual recovery was dependent on preoperative visual acuity, macular involvement, extent of retinal detachment, and trauma.
de la RúaE.R., PastorJ.C., FernándezI.Non-complicated retinal detachment management: variations in 4 years. Retina 1 project; report 1. Br J Ophthalmol2008; 92: 523–5.
2.
HeimannH., BornfeldN., FriedrichsW.Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol1996; 234: 561–8.
3.
MikiD., HidaT., HottaK., ShinodaK., HirakataA.Comparison of scleral buckling and vitrectomy for retinal detachment resulting from flap tears in superior quadrants. Jpn J Ophthalmol2001; 45: 187–91.
4.
WickhamL.Bunce C, Wong D, McGurn D, Charteris DG. Randomized controlled trial of combined 5-Fluorouracil and low-molecular-weight heparin in the management of unselected rhegmatogenous retinal detachments undergoing primary vitrectomy. Ophthalmology2007; 114: 698–704.
5.
SPR Study Group. View 2: the case for primary vitrectomy. Br J Ophthalmol2003; 87: 784–7.
6.
AyraA.V., EmersonJ.W., EngelbertN., HagedornC.L., AdelmanR.A.Surgical management of pseudophakic retinal detachments. A meta-analysis. Ophthalmology2006; 113: 1724–33.
7.
OshimaY., EmiK., MotokuraM., YamanishiS.Survey of surgical indications and results of primary pars plana vitrectomy for rhegmatogenous retinal detachments. Jpn J Ophthalmol1999; 43: 120–6.
8.
Abu El-AsrarA.M.Primary vitrectomy for bullous rhegmatogenous retinal detachments due to complex breaks. Eur J Ophthalmol1997; 7: 322–6.
9.
SharmaT., GopalL., BadrinathS.S.Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment. Ophthalmology1998; 105: 2282–5.
SullivanP.M., LuffA.J., AylwardG.W.Results of primary retinal reattachment surgery: a prospective audit. Eye1997; 11: 869–71.
12.
RubinM.L.The induction of refractive errors by retinal detachment surgery. Trans Am Ophthalmol Soc1975; 73: 452–90.
13.
YoshidaA., FekeG.T., GreenG.J.Retinal circulatory changes after scleral buckling procedures. Am J Ophthalmol1983; 95: 182–8.
14.
Abu El-AsrarA.M., Al KurayaH., Al-GhamdiA.Sympathetic ophthalmia after successful retinal reattachment surgery with vitrectomy. Eur J Ophthalmol2006; 16: 891–4.
BrazitikosP.D., D'AmicoD.J., TsinopoulosI.T., StangosN.T.Primary vitrectomy with perfluoro-n-octane use in the treatment of pseudophakic retinal detachment with undetected retinal breaks. Retina1999; 19: 103–9.
17.
DevenyiR.G., de Carvalho NakamuraH.Combined scleral buckle and pars plana vitrectomy as a primary procedure for pseudophakic retinal detachments. Ophthalmic Surg Lasers1999; 30: 615–8.
18.
BrazitikosP.D., AndroudiS., D'AmicoD.J.Perfluorocarbon liquid utilization in primary vitrectomy repair of retinal detachment with multiple breaks. Retina2003; 23: 615–21.
19.
StangosA.N., PetropoulosI.K., BrozouC.G., KapetaniosA.D., WhathamA., PournarasC.J.Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment. Am J Ophthalmol2004; 138: 952–8.
20.
AfrashiF., ErakgunT., AkkinC., KaskalogluM., MentesJ.Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks. Graefes Arch Clin Exp Ophthalmol2004; 242: 295–300.
21.
BrazitikosP.D., AndroudiS., ChristenW.G., StangosN.T.Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment. A randomized clinical trial. Retina2005; 25: 957–64.
22.
AhmadiehH., MoradianS., FaghihiH.Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment. Six-month follow-up results of a single operation-report No. 1. Ophthalmology2005; 112: 1421–9.
23.
WeichelE.D., MartidisA., FinemanM.S.Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology2006; 113: 2033–40.
24.
Martínez-CastilloV., ZapataM.A., BoixaderaA., FonollosaA., García-ArumiJ.Pars plana vitrectomy, laser retinopexy, and aqueous tamponade for pseudophakic rhegmatogenous retinal detachment. Ophthalmology2007; 114: 297–302.
25.
BonnetM.The development of severe proliferative vitreoretinopathy after retinal detachment surgery. Grade B: a determining risk factor. Graefes Arch Clin Exp Ophthalmol1988; 226: 201–5.
26.
DuquesneN., BonnetM., AdeleineP.Preoperative vitreous hemorrhage associated with rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy?Graefes Arch Clin Exp Ophthalmol1996; 234: 677–82.
27.
GirardP., MimounG., KarpouzasI., MontefioreG.Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina1994; 14: 417–24.
28.
GrizzardW.S., HiltonG.F., HammerM.E., TarenD.A multivariate analysis of anatomic success of retinal detachments treated with scleral buckling. Graefes Arch Clin Exp Ophthalmol1994; 232: 1–7.
29.
HeimannH., Bartz-SchmidtK.U., BornfeldN., WeissC., HilgersR-C, FoersterM.H., For the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment. A prospective randomized multicenter clinical study. Ophthalmology2007; 114: 2142–54.
30.
WickhamL., ConnorM., AylwardG.W.Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?Br J Ophthalmol2004; 88: 1376–9.
31.
CampoR.V., SipperleyJ.O., SneedS.R.Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology1999; 106: 1811–6.
32.
RyanS.J.Traction retinal detachment. XLIX Edward Jackson memorial lecture. Am J Ophthalmol1993; 115: 1–20.
33.
KreigerA.E.Wound complications in pars plana vitrectomy. Retina1993; 13: 335–44.
34.
KochF.H., KreigerA.E., SpitznasM., GlasgowB., FoosR.Y., YoshizumiM.O.Pars plana incisions of four patients: histopathology and electron microscopy. Br J Ophthalmol1995; 79: 486–93.
35.
BeekhuisH., TalsmaM., VreugdenhilW., EgginkF., PeperkampE., Van MeursJ.Changes in refraction after retinal detachment surgery corrected by extended wear contact lenses for early visual rehabilitation. Retina1993; 13: 120–4.
36.
HeimannH., ZouX., JandeckC.Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol2006; 244: 69–78.
37.
SaliconeA., SmiddyW.E., VenkatramanA., FeuerW.Visual recovery after scleral buckling procedure for retinal detachment. Ophthalmology2006; 113: 1734–42.
38.
PastorJ.C., FernándezI., Rodríguez de la RúaE.Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the Retina 1 Project—report 2. Br J Ophthalmol2008; 92: 378–82.
39.
OshimaY., YamanishiS., SawaM., MotokuraM., HarinoS., EmiK.Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol2000; 44: 538–49.
40.
Mart nez-CastilloV., VerdugoA., BoixaderaA., Garcia-ArumiJ., CorcósteguiB.Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol2005; 123: 1078–81.
