Endoscopy-assisted pars plana vitrectomy in retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes

Abstract

Background: Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes.

Methods: Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients' demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance.

Results: Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year.

Conclusion: E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

Keywords: Anterior hyaloid membrane; Anterior proliferative vitreoretinopathy; Endoscopy; Epiciliary membrane; Pars plana vitrectomy; Proliferative vitreoretinopathy; Tractional retinal detachment.

Fig. 1

Illustration and endoscopic images are demonstrating anterior proliferative vitreoretinopathy (PVR) in a phakic patient with tractional retinal detachment. An illustration is demonstrating anterior PVR progression from the left to the right side of the diagram with the anterior hyaloid membrane (AHM) involvement (A). A surgical endoscopic view is demonstrating the anterior PVR scaffolding over the AHM (green arrows), the phakic lens (green arrowhead), and the vitrector cutter tip (green star). An endoscope probe image artifact is observed on the left side of the surgical view during surgery (B). A surgical endoscopic view demonstrating anterior PVR that extends from the retina inferiorly to the AHM and lens capsule superiorly. The same endoscopic probe image artifact is observed on the left side (C)