Pars plana vitrectomy, laser retinopexy, and aqueous tamponade for pseudophakic rhegmatogenous retinal detachment.

Abstract

To evaluate a novel pars plana vitrectomy (PPV) approach with aqueous tamponade for repair of primary pseudophakic rhegmatogenous retinal detachment (RRD). Prospective, noncomparative, interventional case series. Sixty nonconsecutive patients (60 eyes) with primary pseudophakic RRD. Patients underwent PPV alone with injection of perfluoro-n-octane followed by fluid-air exchange and transscleral diode laser retinopexy and then balanced salt solution (BSS) tamponade. All patients were observed for at least 1 year. Anatomic outcome, visual acuity (VA), and complications. The mean follow-up period was 16.4 months (range, 12.1-21.5). Preoperatively, 32 patients (53.3%) had 1 break and 28 patients (46.7%) had 2 to 4 breaks (mean, 2.7). Intraoperatively, 108 retinal breaks were identified, 82 (75.9%) superior and 26 (24%) inferior. Eight breaks in 8 patients that were not seen preoperatively or intraoperatively were diagnosed after air-BSS exchange. Mean preoperative best-corrected VA (BCVA) was 20/700 (range, hand movements [HM]-20/20). Final BCVA was a mean of 20/59 (range, 20/200-20/20). For the 13 eyes with macula-attached RRD, BCVA was the same preoperatively and postoperatively (mean, 20/27; range, 20/50-20/20). For the 47 eyes with macula-detached RRD, the mean BCVA was 20/888 preoperatively (range, HM-20/50) and 20/68 postoperatively (range, 20/200-20/20). Final VA was > or =20/40 in 34 of 60 eyes (56.6%). Primary retinal reattachment (attachment at 1 month postoperatively) was attained in 59 of the 60 patients (98.3%). The single failure was due to a new break postoperatively; this break was treated by pneumatic retinopexy and photocoagulation of the break. At the 12-month follow-up visit, reattachment had been attained in all 60 eyes (100%). Postoperatively, 1 patient (1.6%) had hypotony at the 1-day postoperative visit, but intraocular pressure was 14 mm at the 4-day visit, and 2 patients (3.3%) had mild vitreous hemorrhage during the first 48 hours that resolved spontaneously during the following 10 days. Pars plana vitrectomy with laser retinopexy followed by BSS tamponade is effective for intraoperative sealing of retinal breaks causing pseudophakic RRD. We did not identify safety concerns in this 60-patient series.