JP Berrod, I Hubert, K Naoun, JC Badet Nancy, France

Purpose:

To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachment (RD).

Methods:

Nonrandomized prospective comparative clinical trial including 226 consecutive eyes with 6 months follow-up. Patients underwent PPV, retinal reattachment with fluid-gas exchange, and transcleral cryopexy of the breaks and peripheral retina under control of wide angle viewing system.

Results:

Preoperatively: 125 eyes were phakic and 101 eyes pseudophakic. Among the phakic patients, maculae were detached in 101 eyes (81%), mean extend of RD was 2,7 quadrants and PVR was superior to grade A in 70 eyes (56%). Among the pseudophakic patients, maculae were detached in 72 eyes (71%), mean extend of RD was 2,6 quadrants and PVR was superior to grade A in 40 eyes (40%). Postoperatively: retinas were reattached with one operation in 120 (96%) of the phakic eyes and in 89 (88%) of the pseudophakic eyes. All retinas were reattached with subsequent surgery. The median preoperative visual acuity rose postoperatively from 1,1/10è to 3,8/10è in phakic eyes and to 5/10è in pseudophakic eyes. Refractive error measurement obtained was –2 diopters in phakic patients related to nuclear sclerosis present in 50 eyes (82%) and –0,3 diopter in pseudophakic.

Conclusion:

Primary PPV with fluid-gas exchange and cryopexy is a very effective method to repair retinal detachment whatever the status of the lens but carries a high risk of nuclear sclerosis in phakic eyes.