Clinical outcomes of endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment

Abstract

Summary: We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD). The primary success rate was 98.4% (125/127) without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL) for subretinal fluid drainage.

Purpose: To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD.

Methods: We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated.

Results: Primary and final success rate was 98.4% (125/127) and 100% (127/127), respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (P<0.0001). There were 2 cases (1.6%) of creation of a peripheral drainage retinotomy and 4 cases (3.1%) of using PFCL to suppress movement of the detached retina, but there were no cases of creation of a posterior drainage retinotomy or using PFCL for subretinal fluid drainage. There was 1 case of presumed endophthalmitis after surgery. There were 12 hypotonous cases at postoperative day 1 and one of them needed additional scleral sutures at postoperative day 4 for prolonged hypotony.

Conclusion: The present study demonstrated the efficacy of endoscope-assisted vitrectomy for patients with uncomplicated RRD. To perform endoscope-assisted vitrectomy safely, sufficient closure of sclerotomies is necessary at the end of surgery.

Keywords: endoscope-assisted vitrectomy; endoscopic vitrectomy; ophthalmic endoscope; retinal detachment; rhegmatogenous retinal detachment.

Figure 1

Procedure of ophthalmic endoscope-guided subretinal fluid drainage in pars plana vitrectomy for RRD. Notes: (A) First, the patient’s head is moved toward the position where the primary retinal break is located at the lowest level. In this position, subretinal fluid can easily come out from the retinal break into the vitreous space. (B) We mainly inserted the buckflash needle with a silicone tip (a) from the higher positioned port and the ophthalmic endoscopic probe (b) from the lower positioned port. But we used these instruments oppositely depending on the case or situation. Abbreviation: RRD, rhegmatogenous retinal detachment.

Figure 2

Representative images under the 25-gauge ophthalmic endoscope. Notes: (A) Subretinal fluid drainage was performed through a primary retinal break during fluid–air exchange. (B) Endolaser photocoagulation was performed around the primary retinal break. (C) Small retinal tear was found at peripheral retina (arrow) during fundus inspection under the air condition. (D) Performing endolaser photocoagulation around the small retinal tear.