Outcomes of vitrectomy with inferior retinectomy in patients with recurrent rhegmatogenous retinal detachments and proliferative vitreoretinopathy.
OBJECTIVE
To report the anatomic and functional outcomes of patients treated with vitrectomy and inferior retinectomy for recurrent, rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR).


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Fifty-six patients with recurrent, rhegmatogenous retinal detachments complicated by PVR who underwent an inferior retinectomy for repair.


METHODS
Retrospective review over a 6-year period of patients treated with vitrectomy and inferior retinectomy.


METHODS
The primary outcome was anatomic success, defined as complete retinal reattachment. Secondary outcomes included change in visual acuity, the mean number of operations required for complete retinal reattachment, number of operations before retinectomy, use of silicone oil tamponade, location and extent of retinectomy, whether lensectomy was undertaken, and incidence of postoperative complications.


RESULTS
Complete retinal reattachment was achieved in 52 of 56 patients (93%), with a mean follow-up of 25 months (range, 6-70 months). After retinal reattachment, visual acuity was improved or stabilized in 39 of 56 patients (70%). The mean number of operations for retinal detachment before diagnosis of PVR requiring retinectomy was 1.8 (range, 1-5). Patients undergoing radical anterior vitreous base dissection and lensectomy at the time of first retinectomy had a higher success rate than those who did not: 74% versus 38%, respectively (P = 0.011). Furthermore, tamponade with silicone oil had a higher success rate than tamponade with gas: 71% versus 18%, respectively (P = 0.002). Of the 56 patients, 9 (16%) had 1 or more of the following complications: keratopathy requiring penetrating keratoplasty (n = 4), glaucoma requiring aqueous shunt device (n = 3), and hypotony (n = 3). Silicone oil removal was performed in 26 of 45 patients (58%) before the last follow-up visit, with a 1 in 26 (4%) redetachment rate.


CONCLUSIONS
When combined with anterior base dissection, inferior retinectomy may be useful in the surgical treatment of complex PVR-related retinal detachment. The authors show that with lensectomy, radical anterior base dissection, and inferior retinectomy, anatomic success rates are improved and visual function can be maintained. In addition, silicone oil offers an advantage over gas tamponade in these cases.
Quiram
Polly A
PA
Jules Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA.
Gonzales
Christine R
CR
Hu
Wanda
W
Gupta
Anurag
A
Yoshizumi
Marc O
MO
Kreiger
Allan E
AE
Schwartz
Steven D
SD
D000368:Aged; D004210:Dissection; D005260:Female; D006801:Humans; D007908:Lens, Crystalline / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D011184:Postoperative Period; D012008:Recurrence; D012160:Retina / Q000601:surgery*; D012163:Retinal Detachment / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D012167:Retinal Perforations / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects; D018630:Vitreoretinopathy, Proliferative / Q000150:complications*; D014822:Vitreous Body / Q000601:surgery