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The risk factors and the outcome of iatrogenic retinal breaks during pars plana vitrectomy for rhegmatogenous retinal detachment

Session Details

Session Title: Vitreo Retinal Surgery I

Session Date/Time: Thursday 11/09/2014 | 08:00-10:00

Paper Time: 09:44

Venue: Auditorium

First Author: : C.Geenen UK

Co Author(s): :    M. Dogramaci   T.H. Williamson           

Abstract Details

Purpose:

To report the risk factors and the outcome of iatrogenic retinal breaks during 3-port pars plana vitrectomy (PPV) for rhegmatogenous retinal detachments (RRD).

Setting:

University Hospital of North Durham, CDDFT and St Thomas’ Hospital, London.

Methods:

A total of 1831 PPV operations were included in the study. The study period was between 2001 and 2011. All the data were entered in an electronic patient record database. 75 consecutive eyes of 75 patients developing iatrogenic retinal breaks during primary PPV for RRD were matched to 75 controls. Univariate and multivariate analysis were performed to establish the risk factors.

Results:

Intra-operative iatrogenic retinal breaks developed in 75 eyes (4.09%), which were successfully matched to 75 controls for sex, age and primary indication for surgery. There was no significant difference between the groups in the mean initial BCVA. As the cases and the controls were collected over the same period, surgical techniques were similar between both groups. General anaesthetics were given to 65 out of 75 (86%) eyes with iatrogenic breaks compared to 52 out of 75 (69.6%) eyes in the control group (p=0.019). Proliferative vitreoretinopathy (PVR) that needed a peeling procedure was present in 23 out of 75 (30.7%) eyes with iatrogenic breaks compared to 4 out of 75 (5.3%) eyes in the control group (p=0.00). No statistically significant differences between both groups were found in the side of surgery, the use of 23 gauge instruments or pre-operative pseudophakia. Post-operative secondary retinal detachment was more likely to occur in eyes with iatrogenic retinal breaks (8 out of 75), compared to eyes in the control group (1 out of 75) (p=0.039). There was no statistically significant difference between the two groups in the mean final BCVA, the mean pre- to post-operative change in BCVA, or the mean post-operative follow-up.

Conclusions:

RRD with PVR are associated with a higher risk of developing iatrogenic breaks during PPV. RRD that develop iatrogenic breaks during PPV are associated with higher risk of postoperative detachment.

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