Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments.
OBJECTIVE
To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes.


METHODS
Nonrandomized, prospective, comparative clinical trial.


METHODS
Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol.


METHODS
Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months.


METHODS
Reattachment of the retina and visual outcome were compared to previously published studies.


RESULTS
Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was -0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes.


CONCLUSIONS
Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.
Campo
R V
RV
Retinal Consultants of Arizona, Phoenix 85006, USA.
Sipperley
J O
JO
Sneed
S R
SR
Park
D W
DW
Dugel
P U
PU
Jacobsen
J
J
Flindall
R J
RJ
D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007910:Lenses, Intraocular; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000150:complications*; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery*; D012167:Retinal Perforations / Q000209:etiology / Q000601:surgery; D012591:Scleral Buckling; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D005466:Fluorocarbons; C042852:perflutren; D013459:Sulfur Hexafluoride