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Primary Pars Plana Vitrectomy in Rhematogenous Retinal Detachment
Rynarzewska E., Siwiec-Proscinska J., Meller M., Pecold K.,
K. Marcinkowski University of Medical Sciences Poznan, Department of Ophthalmology (Poznan)
Purpose: Vitrectomy techniques are more commonly used for the primary repair of rhematogenous retinal detachment (RRD) and are applied to a wider spectrum of diseases. Nevertheless performing a vitrectomy for conditions other than RRD with severe proliferative vitreoretinopathy (PVR) or for uncomplicated cases of RRD in which minimal surgery would be the usual procedure of choice remains controversial. The aim of the study was to present efficiency of application of primary pars plana vitrectomy (PPV) in repairing various cases of RRD and to show wider list of indications to perform this procedure.
Method: The data from 50 patients, aged from 3 to 72 years with RRD, who undergone primary PPV with silicon oil or gas endotamponade, were retrospectively reviewed. The classification criteria for vitrectomy excluded the presence of retinal detachment because of injury or intraocular foreign body. The pars plana vitrectomy was applied as procedure of choice in cases of more complex RRD complicated by severe PVR, in pseudophakic eyes or in detachment resulting from posterior break, giant tears or multiple retinal tears located in different quadrants or posterior to the equator. In the second group of cases the minimal or maximal surgery procedure could be considered. These cases of RRD, not complicated by severe PVR were: existence of more than one break, multiple breaks of different size or located in equal distance from ora serrata. Another indications were tears larger than disc diameter, particularly those with attracted flap and visible trend toward building larger tears.
Results: Anatomical success was achieved in above 80% of eyes in first and 100% of eyes in second group. The visual acuity from 0.3 to 1.0 was obtained in 40% cases in first and in above 60 % cases in second group.
Conclusions: The primary pars plana vitrectomy offers certain advantages in the treatment of RRD in comparison to conventional buckling procedure. This procedure may be recommended as a valuable option in selected cases of RRD not complicated by severe PVR.