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Primary vitrectomy for rhegmatogenous retinal detachment – comparison of surgical strategies between 2007 and 2012

Session Details

Session Title: FP-16 Vitreoretinal Surgery IV

Session Date/Time: Sunday 14/09/2014 | 11:00-13:00

Paper Time: 12:20

Venue: Boulevard D

First Author: : K.Krepler AUSTRIA

Co Author(s): :    E. Smretschnig   C. Falkner-Radler   S. Binder        

Abstract Details

Purpose:

To compare three patient cohorts who had primary vitrectomy for rhegmatogenous retinal detachment during the past six years regarding surgical strategies and to evaluate anatomical and functional outcome

Setting:

Department of Ophthalmology, Rudolf Foundation Hospital

Methods:

All patients who had a primary vitrectomy for rhegmatogenous retinal detachment between January 2007 and December 2008 (Group 1), September 2010 and September 2011 (Group 2) and between January and December 2012 (Group 3) were included, for Group 1 and 2 as a retrospective cohort, for 2012 as a prospective cohort. The surgical procedure regarding sclerotomy size, combination with an encircling band and kind of tamponade was correlated to primary and final anatomical success rate and best corrected visual acuity (BCVA). Follow up was 6 months.

Results:

In total 244 eyes (Group 1: 47, Group 2: 97, Group 3: 100) were included. The number of patients treated primarily with vitrectomy as compared to buckle procedure increased substantially during the past years, the percentage of vitrectomy cases accounting for 33% of all primary detachment cases in Group 1, 69% in Group 2 and 87% in Group 3 (p<0.05). Similarily in later years the rate of silicone oil tamponades was reduced significantly in favour of gas tamponades from 79% in Group 1 to 33% in Group 2 and 25% in Group 3 (p<0.05). Vitrectomy was combined with an encircling band in 20%, 32%, and 4.3%, respectively. A 20-gauge system was used in all eyes of Group 1 and a 23-gauge system in all eyes of Groups 1 and 2. PVR rate was higher in Group 1 than in Groups 2 and 3 (39% vs 10%). Primary and final anatomical success rate for the three cohorts was 62% and 96%, 84.5% and 98%, 86.4% and 99%, which means a significantly higher primary success rate in later years. BCVA was 2008 1.07 logMar preoperatively and 0.6 postoperatively in 2008 and 0.86 vs 0.44 in 2012.

Conclusions:

The percentage of patients who were operated with a vitrectomy combined with silicone oil tamponade or in combination with an encircling band was reduced significantly over the past years. This can be explained by the fact that in 2007 and 2008 the rate of PVR cases was higher and only more complex cases with a higher degree of PVR received primary vitrectomy instead of a buckle procedure in our department. A change of our surgical strategy using gas tamponade also in cases with inferior breaks and detachments also reduced the rate of silicone oil cases later on. Less invasive surgical strategies using small incision trocar guided vitrectomy systems and gas as intraocular tamponade are the most common surgical strategy for primary detachments in the latest cohort, silicone oil used only in complex pathologies. This led to a higher primary and final anatomic success rate, but similar functional improvement. Side effects or additional procedures due to encircling bands or silicone oil tamponade could be avoided.

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