Garweg J. G., Brandenberg L., Körner U., Körner F.

Univ.-Augenklinik, Inselspital, CH - 3010 Bern

Background: The vitreous is on the one hand known to harbour growth factors and proliferative cells such as pigment and fibroblasts, and vitrectomy, on the other hand, is responsible for postoperative cataract and glaucoma formation as well as a retarded visual rehabilitation. In the present study, the predictive factors for additional vitrectomy and its influence on the anatomical and functional outcome after extraocular detachment surgery are evaluated.
Patients and Method: This retrospective study is gleaned on the records of 235 primary retinal detachment surgeries performed by two surgeons. Of these 184 were extrasocular buckle procedures (group 1) and 51 combined with primary vitrectomy (group 2). From all patients, postoperative data were recorded retrospectively over 6 months for statistical comparison.
Results: Despite a worse initial situation with higher extension of the detachment (p = 0.015), more often macular involvement (p = 0.016) and higher rate of vitreous hemorrhage (p = 0.002), the anatomical outcome was comparable between the two groups with reattachment rates of 85.9 and 79.5% (p = 0.6). There was no difference in the incidence of PVR [group 1: 30 (16.6%); group 2: 6 (12.3%); p =0.6], or star fold formation [group 1: 12 (6.6%); group 2: 1 (2.2%); p =0.3]. Due to a higher portion of macula involvement and a postoperative cataract formation, visual rehabilitation was less in primary vitrectomy cases.
Conclusion: Despite a higher risk situation, the anatomical success was in combined primary vitrectomy not worse than in surgery for uncomplicated retinal detachment. Obviously, vitrectomy was able to compensate the preoperative risk of PVR formation.

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