Session Title: Free Paper Session 28: Vitreoretinal Surgery VII
Session Date/Time: Sunday 10/09/2017 | 12:00-13:30
Paper Time: 12:30
Venue: Room 116
First Author: : Y.Otsuka JAPAN
Co Author(s): : K. Suda A. Oishi A. Tsujikawa T. Kurakazu
Small-gauge pars plana vitrectomy (PPV) is the current standard procedure for the treatment of rhegmatogenous retinal detachment (RRD). It is known that multiple subretinal fluid (SRF) blebs occasionally occur after scleral buckling surgery; however, the incidence rate, clinical course and risk factors of SRF blebs following PPV are not well known. The purpose of this study is to investigate the incidence and risk factors for multiple SRF blebs after PPV.
Institutional retrospective study
We reviewed clinical records of consecutive patients with primary spontaneous RRD who were treated with PPV by the same surgeon at Hidaka Medical centre between February 2012 and July 2016. Spectral domain optical coherence tomography (SD-OCT) examinations were performed one month after the surgery. Horizontal and vertical line scans (20 degrees) through the fovea were obtained. We defined multiple SRF blebs as more than three independent bleb-like accumulations and recorded the presence or absence thereof using SD-OCT and infrared reflectance imaging. We compared characteristics including age, sex, axial length, use of 25G or 27G system, creation of intentional drainage retinotomy, use of cryotherapy, postoperative visual acuity, and the duration between the symptom and surgery between eyes with and without multiple SRF blebs.
After the exclusion of two patients who developed postoperative proliferative vitreoretinopathy, 108 eyes from 106 patients (76 men and 32 women, mean age: 58.9 ± 9.0 years, range: 30 79 years) were included in this study. Among the included eyes, 36 showed macula-off RRD. Twenty-five gauge system was employed in 64 eyes and 27G in 44 eyes. Intentional drainage retinotomy was performed in 12 eyes and transscleral cryopexy in 15 eyes. Sulfur hexafluoride was used as a tamponade in all cases. The mean axial length was 25.15 mm, and the mean logMAR one month after the surgery was 0.02. Multiple SRF blebs were observed in 8 eyes (7.4%) one month after surgery. In all cases, the number and size of the blebs decreased during the follow up period. In three of the cases, the lesions had completely resolved within one year of the surgery. Cases with multiple SRF blebs occurred more frequently with 27G-surgery and with the creation of intentional drainage retinotomy (P < 0.001 for both). There was no significant difference in the other investigated factors.
Multiple SRF blebs can be observed after small gauge PPV. Multiple SRF blebs after PPV were associated with the 27G vitrectomy system and with intentional drainage retinotomy. We postulate that the occurrence of SRF blebs can be attributed to the viscous SRF remaining after aspiration with small caliber instruments through a small retinotomy. While the supernatant is easily removed, it may be difficult to remove the high-density component of the SRF completely with a 27G system through the small retinotomy. Larger, prospective studies are necessary to determine the pathogenesis of multiple SRF blebs and its impact on visual function.