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Strategy in “Normal RRD”

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First strategy in what we could say «normal» RDs.

First strategy in what we could say «normal» RDs.

Concerning PVR stage 0 and A, for equatorial holes and normal tears, not performing a vitrectomy seems better than performing a vitrectomy. Although the p value is not significant at a level of 5% for the effective failure rate, it is obviously highly significant for the rate of remaining silicone.

Concerning PVR stage 0 and A, for equatorial holes and normal tears, not performing a vitrectomy seems better than performing a vitrectomy. Although the p value is not significant at a level of 5% for the effective failure rate, it is obviously highly significant for the rate of remaining silicone.

When looking at the failure rates in relation to the pump used, the difference for true failure rates becomes significant. For PVR stage 0 and A, without choroidal detachment and hypotony, the statistics show that the results when not performing any vitrectomy are better than when performing a vitrectomy with a vacuum control pump.

When looking at the failure rates in relation to the pump used, the difference for true failure rates becomes significant. For PVR stage 0 and A, without choroidal detachment and hypotony, the statistics show that the results when not performing any vitrectomy are better than when performing a vitrectomy with a vacuum control pump.

For PVR stages 0 and A, with only equatorial holes and normal tears, when a vitrectomy was performed, the cases treated with an additional buckle developed  a higher true failure rate than when a buckle was not performed. We can conclude that at the very least a buckle in a vitrectomy case does not significantly improve the success rate.

For PVR stages 0 and A, with only equatorial holes and normal tears, when a vitrectomy was performed, the cases treated with an additional buckle developed a higher true failure rate than when a buckle was not performed. We can conclude that at the very least a buckle in a vitrectomy case does not significantly improve the success rate.

Let’s see now if pneumatic retinopexy is a valid procedure.  At first sight , it seems that for PVR stages 0 and A, for equatorial holes and normal tears, when no vitrectomy is performed, it is better to perform a buckle. By the way, that is the strategy followed by most surgeons (1342 vs 119). However, this result is significant for the true failure rate at only 12%. Still, for the rate of remaining silicone, this result is statistically significant at a level of 5%.

Let’s see now if pneumatic retinopexy is a valid procedure. At first sight , it seems that for PVR stages 0 and A, for equatorial holes and normal tears, when no vitrectomy is performed, it is better to perform a buckle. By the way, that is the strategy followed by most surgeons (1342 vs 119). However, this result is significant for the true failure rate at only 12%. Still, for the rate of remaining silicone, this result is statistically significant at a level of 5%.

In fact, if we consider only the RDs induced by atrophic holes, pneumatic retinopexy must be considered as a valid procedure even if the p value is not significant.

In fact, if we consider only the RDs induced by atrophic holes, pneumatic retinopexy must be considered as a valid procedure even if the p value is not significant.

But when the Rds is induced by a tear, pneumatic retinopexy induced a higher effective failure rate than the cryo + buckle and this is significant.

But when the Rds is induced by a tear, pneumatic retinopexy induced a higher effective failure rate than the cryo + buckle and this is significant.

Let’s consider now the stage B.  For RDs induced by equatorial holes and normal tears, when choroidal detachment and hypotony cases are excluded, the statistic results show that performing a vitrectomy is highly better than not performing a vitrectomy as far as the true failure rate is concerned. By the way, most surgeons follow this strategy (740 vs 177).

Let’s consider now the stage B. For RDs induced by equatorial holes and normal tears, when choroidal detachment and hypotony cases are excluded, the statistic results show that performing a vitrectomy is highly better than not performing a vitrectomy as far as the true failure rate is concerned. By the way, most surgeons follow this strategy (740 vs 177).

As far as the tamponade is concerned, although there is no statistical difference for effective failure rate between gas and silicone, it is obvious that the rate of remaining silicone with gas is far lower than with silicone tamponade. If considering that remaining silicone cases will have to be re operated, it seems that gas tamponade is more appropriate than silicone tamponade.

As far as the tamponade is concerned, although there is no statistical difference for effective failure rate between gas and silicone, it is obvious that the rate of remaining silicone with gas is far lower than with silicone tamponade. If considering that remaining silicone cases will have to be re operated, it seems that gas tamponade is more appropriate than silicone tamponade.

As a summary, we can conclude that, in absence of aggravating factors, and when the RD is induced by atrophic holes or small tears, we can propose, for stages 0, A and B, this decision tree.

As a summary, we can conclude that, in absence of aggravating factors, and when the RD is induced by atrophic holes or small tears, we can propose, for stages 0, A and B, this decision tree.

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