[Place of "exploratory vitrectomy" in the treatment of retinal detachment without proliferative vitreoretinopathy].
BACKGROUND
One of the principal causes that may contribute to failure in the treatment of retinal detachment without PVR is the inability to detect the retinal break before and during surgery. We propose in these cases the use of exploratory primary vitrectomy allowing the location and the treatment of the retinal break.


METHODS
We have studied retrospectively 19 cases of retinal detachment without any preoperatively identified break. In 14 cases, it was a pseudophakic detachment (the IOL was in the posterior chamber with an optic between 5 and 6 mm), in 5 cases it was a phakic detachment. Peripheral fundus was examined with the vitrectomy probes with and without perfluorocarbon liquid injection. Cryotherapy or endophotocoagulations have been used to create a chorio-retinal adhesion and a gaz tamponade was used without scleral buckling procedure.


RESULTS
In 2 cases, no retinal break was found. In the other cases, the retinal tear has been identified during basal vitrectomy in 8 cases, during injection of perfluorocarbon in 2 cases and during the vitrectomy done forward the PFLC in 7 cases. The retinal break was identified as a small retinal tear along the posterior margin of the vitreous base in 15 cases (several in 2 cases) and as atrophic hole in 2 cases.


CONCLUSIONS
Exploratory vitrectomy is an interesting technique to identify a retinal break when a scleral indentation cannot offer a good visualization of the anterior retina or retinal tears. In young phakic patients, a primary vitrectomy may be dangerous but seems to be justified in pseudophakic eyes. The research of the tear is sometimes facilitated by a peroperative tamponade of the retro equatorial retina.
Gastaud
P
P
Service d'Ophtalmologie, Hôpital Saint Roch, Devoluy, 06000 Nice.
Rouhette
H
H
Negre
F
F
Leguay
J M
JM
Durafourg
F
F
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D012163:Retinal Detachment / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology