Advanced Vitrectomy Surgery in Rhegmatogenous Retinal Detachment; Indications and Techniques

2019 ◽  
pp. 205-210
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Treatment Modalities ◽  
Success Rates ◽  
Retinal Tears ◽  
Pars Plana ◽  
Anatomical Success ◽  
Vitrectomy Surgery

The main goal in the treatment of rhegmatogenous retinal detachment (RRD) is the localization of retinal tears, removal of tractions, and closure of retinal tears. Despite the use of pneumatic retinopexy, scleral buckling, and vitrectomy as standard treatment modalities, the preference for pars plana vitrectomy (PPV) in the treatment of RRD has increased steadily in recent years. The reason for this increase is the widespread use of small-sized transconjunctival surgery, improvement of bimanual surgery, use of liquid perfluorocarbons, improved vitrectomy devices and more safe and successful removing of peripheral vitreous bases, visualization of membranes with vital dyes, safe retinopexy with use of curved laser probe even with phakic cases. Besides these, PPV and advanced surgical techniques are more needed in complicated detachments. Nevertheless, the surgeon has a specially important role in the surgical technique of choice. Although the control of the procedures can be performed much more successfully with the PPV in the case of complicated RRD patients during surgery, anatomical success rates are still not very high. In this article, the applications of advanced vitrectomy surgery in RRD are discussed in detail.

scholarly journals Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ritesh Shah ◽  
Raghunandan Byanju ◽  
Sangita Pradhan ◽  
Sudha Ranabhat
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Correct Selection ◽  
Success Rates ◽  
Scleral Buckle ◽  
Preoperative Visual Acuity ◽  
Anatomical Success

Introduction. Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method. Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results. A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion. Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

scholarly journals Scleral buckling—a brief historical overview and current indications

2019 ◽  
Vol 258 (3) ◽  
pp. 467-478
Author(s):  
Aijing Wang ◽  
Martin P. Snead
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Techniques ◽  
Scleral Buckling ◽  
Effective Technique ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Pars Plana ◽  
Retinal Hole ◽  
The Right

AbstractThe key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

scholarly journals Outcomes of Rhegmatogenous Retinal Detachment

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Sidrah Riaz ◽  
Muhammad Tariq Khan ◽  
Khurram Azam Mirza
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Success Rates ◽  
Cross Sectional ◽  
Pars Plana ◽  
Anatomical Success ◽  
Anatomical Success Rate

Purpose:  To study demographic characteristics and treatment outcomes of Rhegmatogenous retinal detachment in a private Vitreo-retinal setup of Lahore. Study Design:  Cross sectional Observational study. Place and Duration of Study:  Private Vitreo-retinal setup, from March 2017 to April 2019. Methods:  Total 102 patients with Rhegmatogenous retinal detachment (RRD) were included. Patients with retinal detachment other than RRD were excluded. Detailed history and ocular examination was performed. Type of break, procedure adopted for RRD repair and type of endo-tamponade were also recorded. These patients had either 23 G pars plana vitrectomy (PPV) or scleral buckling (SB) procedures or combined sclera buckling with PPV. Patients were followed-up for six months. Results:  Out of 102 total RRD cases, 63.70% were males and 36.30%were females. Mean age was 47.44 ± 18.44. Macula was on in 48% and off in 52%. Phakic patients were 46.50%, pseudophakic 48.50% and 5.10% were aphakic. Position of break in RRD was superotemporal in 39.2%, inferotemporal in 30.4% and inferonasal in 2.9%. Total RD was observed in 27.5% patients. One or more breaks were identified in 82.4% patients and giant tear in 4.9%. Three ports 23 G PPV was done in 64.7%, PPV with IOL in 18.6%, scleral buckling in 10.8% and combined PPV + SB in 5.9% patients. The anatomical success rate was observed in 96.07%, 3.9% needed second surgery to get anatomical success in six months follow-up. Conclusion:  Anatomical success rates in retinal attachment surgeries in experienced hands is comparable with more developed retinal centers of the world. Key Words:  Rhegmatogenous retinal detachment, Pars plana vitrectomy, Scleral buckling, Silicon oil.

Repair of Primary Noncomplex Rhegmatagenous Retinal Detachment

2013 ◽  
Vol 06 (02) ◽  
pp. 135 ◽  
Author(s):  
Eric W Schneider ◽  
Mark W Johnson ◽  
◽  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Surgical Approaches ◽  
Short Discussion ◽  
Pneumatic Retinopexy ◽  
Pars Plana

With the development of pars plana vitrectomy in the 1970s and pneumatic retinopexy in the 1980s, the primacy of scleral buckling for repair of rhegmatogenous retinal detachment (RRD) came under challenge. While a degree of consensus exists for certain forms of complex RRD, there remains little agreement concerning the optimal treatment of primary noncomplex RRD. This debate is further muddied by application of adjuvant procedures to supplement the primary surgical approach. This article aims to present the current evidence regarding repair of primary noncomplex RRD. A brief summary of primary surgical approaches—pneumatic retinopexy, scleral buckling, and pars plana vitrectomy—will be presented along with a short discussion on potential adjuvant procedures. The remainder of the article focuses on reported outcomes for the different treatment modalities for primary noncomplex RRD.

scholarly journals Scleral Buckling for Rhegmatogenous Retinal Detachment Associated with Pars Planitis

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Yong-Kyu Kim ◽  
Wontae Yoon ◽  
Jae Kyoun Ahn ◽  
Sung Pyo Park
Keyword(s):  
Retinal Detachment ◽  
High Myopia ◽  
Rhegmatogenous Retinal Detachment ◽  
Scleral Buckling ◽  
Surgical Approaches ◽  
Success Rates ◽  
Visual Outcomes ◽  
Pars Planitis ◽  
Preoperative Risk Factors ◽  
Anatomical Success

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis.Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups.Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p<0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%,p=0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors.Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

scholarly journals Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Yasser Helmy Mohamed ◽  
Kozue Ono ◽  
Hirofumi Kinoshita ◽  
Masafumi Uematsu ◽  
Eiko Tsuiki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Success Rate ◽  
Rhegmatogenous Retinal Detachment ◽  
Multiple Logistic Regression Analysis ◽  
University Hospital ◽  
Success Rates ◽  
Pars Plana ◽  
Anatomical Success ◽  
Anatomical Success Rate

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD).Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60).Results. This study evaluated 422 eyes of 411 patients with a mean age of57.7±11.2years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean =3.14±1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P=0.002) and the presence of multiple tears (P=0.01).Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

Bilateral Retinal Detachment in Marfan's Syndrome

1998 ◽  
Vol 8 (2) ◽  
pp. 102-105 ◽  
Author(s):  
D. Dotrelova
Keyword(s):  
Retinal Detachment ◽  
Retinal Disease ◽  
Scleral Buckling ◽  
Marfan’S Syndrome ◽  
Marfan's Syndrome ◽  
Retinal Tears ◽  
Scleral Buckling Procedure ◽  
Pars Plana ◽  
Highly Correlated ◽  
Anatomical Success

Purpose Bilateral retinal detachment (RD) in Marfan's syndrome (MS) has a typical preoperative, operative, and post-operative course. This study describes symmetry of retinal tears and bilateral RD surgery in five MS patients over a period of 15 years. Methods Six eyes with uncomplicated RD were operated on using the scleral buckling procedure, and four eyes with complicated RD were operated using a pars plana vitrectomy (PPV) and inner retinal tamponade with silicon oil. Results Complete retinal reattachment was achieved in seven eyes. Partial anatomical success with attached macula was achieved in one eye. The surgery failed in two eyes. Final visual acuity was between 0.66 and 0.33 in three eyes, and between 0.25 and 0.1 in five; two eyes had no light perception. Conclusions The course of the bilateral retinal disease highly correlated with the symmetry of retinal defects.

scholarly journals Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade

2021 ◽  
Vol 14 (6) ◽  
pp. 936-939
Author(s):  
Kiichiro Kusaba ◽  
◽  
Tsuneaki Handa ◽  
Yukihiko Shiraki ◽  
Takuya Kataoka ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Retinal Detachment ◽  
Success Rate ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Gas Tamponade ◽  
Retinal Tears ◽  
Pars Plana ◽  
Anatomical Success ◽  
Anatomical Success Rate

AIM: To evaluate the safety and efficacy of a minimally restricted face-down postoperative positioning following pars plana vitrectomy (PPV) with gas tamponade for primary rhegmatogenous retinal detachment (RRD). METHODS: Patients with primary RRD treated with PPV and gas tamponade and followed up for at least 6mo were selected for the study. All phakic eyes underwent simultaneous cataract surgery. The patients were required to be in a postoperative position that prevented downward flow of retinal tears. Patients with macular detachment were positioned face-down for only a couple of hours. The patients were assessed for preoperative and postoperative best-corrected visual acuity (BCVA), anatomical retinal reattachment rate, and postoperative complications. RESULTS: In total, 40 eyes of 39 patients with primary RRD were included in the study. A single tear was present in 30 eyes (75.0%), multiple retinal tears were present in nine eyes (22.5%), and oral dialysis was present in one eye (2.5%). The anatomical success rate was 90.0% (36 cases) after the primary surgery, and the final anatomical success rate was 100%. The BCVA improved significantly (P<0.001) from 0.75 logarithm angle of resolution (logMAR) preoperatively to 0.12 logMAR at the final visit. Postoperative complications included intraocular pressure elevation (≥25 mm Hg) in 11 patients (27.5%), fibrin formation in two patients (5.0%), pupillary capture of the intraocular lens in two patients (5.0%), and posterior synechia in one patient (2.5%). CONCLUSION: A minimally restricted face-down and flexible postoperative positioning after PPV and gas tamponade for primary RRD is effective and safe.

scholarly journals Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Keiko Otsuka ◽  
Hisanori Imai ◽  
Ayaka Fujii ◽  
Akiko Miki ◽  
Mizuki Tagami ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Success Rates ◽  
Significant Difference ◽  
Pars Plana ◽  
Anatomical Success ◽  
Better Than ◽  
Baseline Demographic

Aim. To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD).Design. A retrospective nonrandomized clinical trial.Methods. A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed.Results. Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1andp=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and −0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02andp=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63andp=0.21, resp.).Conclusion. The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

scholarly journals Bilateral Simultaneous Rhegmatogenous Retinal Detachment following Laser in situ Keratomileusis

2016 ◽  
Vol 7 (2) ◽  
pp. 340-344 ◽  
Author(s):  
Erhan Yumusak ◽  
Kemal Ornek ◽  
Fatma Ozkal
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Scleral Buckling ◽  
Laser In Situ Keratomileusis ◽  
Pars Plana ◽  
Silicone Oil Tamponade ◽  
The Right ◽  
Vitrectomy Surgery

A 21-year-old woman developed simultaneous rhegmatogenous retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. She underwent pars plana vitrectomy surgery combined with endolaser photocoagulation and silicone oil tamponade in the right eye. A week later, pneumatic retinopexy was done in the left eye. As the retinal tear did not seal, 360° scleral buckling surgery was performed and retina was attached. Bilateral simultaneous rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication.

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