Churashov S.V., Kulikov A.N., Shevalova T.N.
S.M. Kirov Military medical academy, St. Petersburg
The inferior recurrence of retinal detachment with proliferative vitreoretinopathy of grade C «anterior» are big problems of vitreoretinal surgery.
Aim: To analyze functional and anatomical outcomes in inferior recurrence of rhegmatogenous retinal detachment depending on the surgical approach
Methods: Eighty-one eyes of 81 patients (47 males and 34 females with a mean age of 54,8±14,1 years) who demonstrated at least one inferior recurrence of RRD were included in this retrospective study. All patients were categorized as received either circular scleral buckling, pars plana vitrectomy, a combination of circular scleral buckling and pars plana vitrectomy, pars plana vitrectomy with retinotomy, or pars plana vitrectomy with retinotomy and short-term postoperative perfluorocarbon liquid tamponade. All cases were followed-up until successful retinal reattachment or third recurrence.
Results: After the treatment of first recurrence, the rate of redetachment in a combination of circular scleral buckling and pars plana vitrectomy group was statistically significantly lower than that of pars plana vitrectomy (p = 0.0012), pars plana vitrectomy with retinotomy (p = 0.028), and pars plana vitrectomy with retinotomy and short-term postoperative perfluorocarbon liquid tamponade (p = 0.047) group. There was no statistically significant difference between a combination of circular scleral buckling and pars plana vitrectomy, pars plana vitrectomy with retinotomy, pars plana vitrectomy with retinotomy and short-term postoperative perfluorocarbon liquid tamponade groups in the recurrence rate after the treatment of the second recurrence (42 eyes). However, there was a statistically significant (p = 0.016) trend towards a decrease of recurrence rate after pars plana vitrectomy with retinotomy and short-term postoperative perfluorocarbon liquid tamponade. There was no statistically significant improvement of best-corrected visual acuity in either study group (p>0.05) after both first and second recurrence surgery.
Conclusion: The patients with first inferior recurrence of rhegmatogenous retinal detachment may benefit from circular scleral buckling as an adjunct to pars plana vitrectomy. Retinotomy and short-term postoperative perfluorocarbon liquid tamponade in the second recurrence may allow better anatomical outcomes without functional improvement.
Keywords: recurrence of retinal detachment, scleral buckling, retinotomy, pars plana vitrectomy, silicone tamponade, proliferative vitreoretinopathy.
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