Assessing the outcome of relaxing retinectomy in treating recurrent rhegmatogenous retinal detachments
Amin, Gopal Dhirubhai
MetadataShow full item record
The purpose of this study is to evaluate the effectiveness of pars plans vitrectomy with relaxing retinectomy as treatment for recurrent rhegmatogenous retinal detachments (RRD) complicated by proliferative vitreoretinopathy (PVR). This retrospective case series was conducted with data from a single retina surgeon at Beth Israel Deaconess Medical Center. The medical records of 101 patients who underwent pars plana vitrectomy (PPV) with relaxing retinectomy for retinal detachment with PVR between January 2006 and August 2016 were identified. Exclusionary criteria eliminated patients with proliferative diabetic retinopathy, tractional retinal detachments, and open globe trauma, leaving a total of 57 participants (n=57 eyes) with rhegmatogenous retinal detachment complicated by PVR of grade C or more. All participants were initially treated with three-port PPV with membrane peeling combined with relaxing retinectomy, barrier endolaser photocoagulation, and silicone oil tamponade (n=48) or gas tamponade with SF6 (n=7) or C3F8 (n=2). The primary outcome measures were complete retinal reattachment for a minimum of 3 months and final visual acuity. Final anatomical success was achieved in all 57 patients. Successful reattachment was observed after one surgery in 40 of 57 eyes (70.2%). Sixteen of the 17 re-detachments were successfully reattached after one reoperation. One case required a third surgery to achieve complete reattachment. Four patients developed hypotony defined as intraocular pressure (IOP) < 5 mmHg (7%). A significant difference between pre- and postoperative best corrected visual acuity (BCVA) was defined as a change by at least 2 snellen lines. Of the 50 patients for whom BCVA was documented, visual acuity improved in 27 patients (63%), remained the same in 10 patients (23%), and worsened 6 patients (14%). Thirty-seven (87%) participants overall were had visual acuity greater or equal to 5/200 at 3-months post-operatively. Our study demonstrated good anatomic and visual outcomes after retinectomy for patients with RRD associated with PVR, which were significantly better than outcomes in the Silicone Oil Study Report 5. The high rate of success reported in our study is likely due to improved technology and techniques, and possibly the proactive use of retinectomy in less severe cases of PVR. The results of our study demonstrate that the use of relaxing retinectomy in patients with RRD and PVR provides an effective method for definitively relieving retinal traction and improving anatomic and visual outcomes.