Efficacy and Safety of Vitrectomy without Using Perfluorocarbon Liquids and Drainage Retinotomy Associated with Postoperative Positioning Based on Residual Subretinal Fluid for Rhegmatogenous Retinal Detachment

Abstract

Medical records of 75 eyes from 75 consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV) were analyzed. Inclusion criteria were patients with RRD who underwent primary 23- or 25-gauge PPV with air, gas, or SiO tamponade and performed by a single surgeon, no use of perfluorocarbon liquids (PFCL) and drainage retinotomy, and follow-up ≥ six months. Exclusion criteria were patients who underwent previous vitreoretinal surgery, proliferative vitreoretinopathy (PVR) more than grade B, giant tears, and encircling band associated with PPV. The main endpoint was the anatomical retinal reattachment rate after a single surgical procedure. Secondary endpoints were best-corrected visual acuity (BCVA), postoperative retinal displacement, and intraoperative and/or postoperative complications. Primary anatomical success was achieved in 97.3% of cases using this modified surgical procedure. Retinal slippage occurred only in 28.2% of patients and it was not observed in all cases of macula-on RRD. The mean logMAR of the BCVA significantly improved in 92% of patients and no intraoperative complications were observed. The results suggest that complete subretinal liquid drainage is not mandatory for all RRD cases treated with PPV and that using PFCL and performing a drainage retinotomy are not essential in eyes with primary RRD and PVR less than grade B. Postoperative positioning after PPV for uncomplicated RRD based on the presence or absence of residual subretinal fluid at the end of surgery could limit the occurrence of postoperative retinal displacement, while promoting patient compliance.

Figure 1

Preoperative SD-OCT image (a) and six weeks' postoperative SD-OCT image (b) obtained after macula-on RRD surgery. Despite the proximity of the subretinal fluid to the macula (a), the anatomical reattachment of the retina without macular changes (b) demonstrates that the modified surgical procedure used in this study to treat uncomplicated RRD is efficacy.

Figure 2

Preoperative SD-OCT image (a) and six weeks' postoperative SD-OCT image (b) obtained after macula-off RRD surgery. Despite the fact that a residual fluid under the macula at the end of the surgical procedure was left, the anatomical macula reattachment appears satisfactory (b).

Figure 3

FAF (a) and SD-OCT (b) images six weeks after macula-off RRD surgery. White arrows pointing to hyperfluorescent lines (a) indicate the preoperative position of retinal vessels. Retinal displacement was not observed in cases of macula-on RRD.