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Effect of lens status in the surgical success of 23-gauge primary vitrectomy for the management of rhegmatogenous retinal detachment

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 18/09/2015 | 14:30-16:00

Paper Time: 14:38

Venue: Athena

First Author: : M.Maia BRAZIL

Co Author(s): :    O. Junior   E. Badaro   A. Maia   F. Arevalo   L. Wu   M. Farah

Abstract Details

PURPOSE:To determine the effects of lens status on the success rate of primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment using either perfluoropropane gas (C3F8) or Silicone oil (SO) tamponade.

Setting:

This study was conducted at the Vitreoretinal Surgery Unit of the Department of Ophthalmology - Federal University of São Paulo - São Paulo - Brazil

Methods:

A retrospective chart analysis of 97 eyes from 92 patients with rhegmatogenous retinal detachment (RRD) with no proliferative vitreoretinopathy (PVR) that were treated with primary 23-gauge PPV. Eyes included in this were phakic (n = 28), pseudophakic (n = 41), or phakic eyes subject to simultaneous phacoemulsification, intraocular lens implantation, and PPV during primary RRD repair (n = 28). Tamponade at the end of PPV was with either C3F8 (n = 65) or SO (n = 32). Success was defined as retinal reattachment at 1 year follow-up after a single procedure in eyes submitted to C3F8; in eyes treated with SO, the success rate was defined as retina reattached 1 year after oil removal. Statistical comparisons were made between groups using chi-square, Fisher’s exact test, Kruskal–Wallis, Mann–Whitney, and multivariate analysis. All eyes were operated by 2 experienced retina surgeons and had a minimum follow-up of 12 months. Inclusion criteria: RRD and no PVR or until CP1 classification treated with primary vitrectomy and follow up of 12 months. Exclusion criteria; eyes with any PVR with stages greater than CP1, RRD due to eye trauma, giant retinal tears, proliferative diabetic retinopathy, previous ocular surgeries other than cataract surgery and blood dyscrasias.

Results:

The vitreoretinal redetachment rate in eyes subjected to C3F8 tamponade was significantly higher (28.6%) for phakic eyes (P = 0.011) compared with pseudophakic or phakic eyes that underwent to phacoemulsification and intraocular lens implantation (4.5%). Eyes in which SO was used at the end of the surgical procedure demonstrated a similar trend of higher reoperation rates in phakic eyes (28.6%) compared with pseudophakic or phakic eyes (8%) subjected to phacoemulsification and intraocular lens implantation. No statistically significant differences were found between groups in relation to the number of tears (P = 0.863) and their location (inferior: P = 0.189, superior: P = 0.708, nasal: P = 0.756, and temporal: P = 0.08).

Conclusions:

The success rates of primary 23-gauge PPV with either C3F8 or SO tamponade in pseudophakic eyes with rhegmatogenous retinal detachment was higher than the same procedure performed in phakic eyes. Combined phaco PPV may be an alternative for management of RRD. Still, the retrospective and limited data presented is too preliminary to suggest or recommend that practitioners perform simultaneous combined cataract surgery with retinal detachment and requires further studies in a larger and prospective design to confirm these findings.

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