Anatomic and visual outcomes of 23-G vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment

Abstract

Purpose: To evaluate the anatomic success rate, visual acuity (VA) changes, and complications of 23-G vitrectomy without associated scleral procedures for the treatment of primary rhegmatogenous retinal detachment (PRRD).

Methods: Patients diagnosed with PRRD were considered for inclusion. Patients with evidence of proliferative vitreoretinopathy or coexisting ocular pathologies were excluded. Surgery consisted of 23-G vitrectomy with endolaser photocoagulation of retinal breaks and fluid-air-gas (12% C3F8) exchange. Minimum follow-up was 3 months.

Results: A total of 133 eyes of 118 patients were included. Fifty eyes were phakic and 83 pseudophakic. Mean time from diagnosis to surgery was 6.9 days (range 1-40). Mean VA improved significantly from 20/50 (range: hand movements to 20/20) to 20/30 (range: counting fingers to 20/16), with no statistically significant differences between phakic and pseudophakic eyes (p = 0.233). Visual acuity improved to 20/40 or better in 104 eyes (78.2%). A redetachment developed in 5 eyes (3.8%), so the primary anatomic success rate was 96.2%. Four eyes required a second surgical procedure and one eye a third to achieve retinal reattachment. Cataract progression in phakic eyes made cataract surgery necessary within 1 year of vitrectomy in 12/50 (24%) eyes. Subretinal perfluoro-N-octane (PFO) was detected in 6 eyes (4.5%).

Conclusion: Twenty-three--gauge vitrectomy without scleral buckling seems to be an effective technique for the treatment of PRRD without proliferative vitreoretinopathy. The high anatomic success rate was comparable to that previously described with 20 G and scleral buckling. Complications were similar to those described for 20-G vitrectomy, except for retained subretinal PFO, which has a higher rate.