Utility of Removal of Vitreous Cortex Remnants during Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Abstract

Purpose: To investigate the prevalence of vitreous cortex remnants (VCR) in primary rhegmatogenous retinal detachment (RRD) and the utility of VCR removal using diamond-dusted membrane scrapers (DDMS) during pars plana vitrectomy (PPV).

Methods: One hundred and eighty-seven eyes (187 consecutive patients) were retrospectively studied. We evaluated the prevalence of VCR on the retinal surface extending from the macula to outside the vascular arcade in eyes that underwent PPV for primary RRD by a single surgeon between July 2014 and February 2021. The VCR outside the vascular arcade was completely removed using a DDMS. Preoperative factors and surgical outcomes were compared between eyes with VCR removed intraoperatively to those without VCR.

Results: VCR was present and removed (group A) in 86 (46%) eyes and absent (group B) in 101 (54%) eyes. Patients with VCR were significantly older than those without (p = 0.006). The preoperative BCVA (logMAR) tended to be worse in group A (1.23 ± 0.92 [Snellen equivalent, 20/340]) than in group B (1.03 ± 0.89 [20/214]), however, the difference was not statistically significant (p = 0.095). There were no between-group differences in postoperative BCVA (group A; 0.44 ± 0.54 [20/55]; group B; 0.42 ± 0.50 [20/53]; p = 0.38). Single surgery anatomic success (group A; 90%, group B; 91%, p = 0.573) and the incidence of postoperative PVR (group A; 9%, group B; 6%, p = 0.554) were comparable between the groups.

Conclusions: Nearly half of the patients had VCR, which was more likely to occur in older patients. VCR removal resulted in favorable functional and anatomic outcomes similar to those in eyes without any VCR in patients with RRD.

Keywords: Rhegmatogenous retinal detachment vitreous cortex remnants diamond-dusted membrane scrapers pars plana vitrectomy posterior vitreous detachment proliferative vitreoretinopathy epiretinal membrane.