http://www.evrs.eu/medias/2006/congress/Primary-Vitrectomy-in-the-Treatment-of-Retinal-Detachment-in-Highly-Myopic-Eyes-with-Axial-Length-Over-30mm.swf

Gregoire Minoyan, MD (Nancy, France), Jean-Paul Berrod, MD (Nancy, France), Alexandre Guillaubey (Dijon, France), Isabelle Hubert, MD (Nancy, France), Catherine Creuzot-Garcher, MD (Dijon, France)

PURPOSE:

To present anatomical and functional outcome of pars plana vitrectomy (PPV) alone and fluid gas exchange with cryo or laser coagulation in the treatment of primary regmatogenous retinal detachment (RD) in highly myopic eyes and to find out risk factors for relapse.

METHODS:

Retrospective case series including 63 consecutive eyes with axial length greater than 30 mm who underwent PPV alone for primary repair of RD between October 1999 and February 2005. All eyes underwent PPV with non expansible gas-air mixture tamponade using SF6, C2F6 or C3F8. Retinopexy was performed using only cryo in 43 cases (68%) only laser photocoagulation in 15 cases (24%) and both in the remaining. Removal of adherent cortical
vitreous plaque and internal limiting membrane peeling was systematically conducted in the presence of a posterior dehiscence. Mean follow-up was 45 months.

RESULTS:

Twenty nine RD were secondary to peripheral breaks, 17 to macular holes (MH) and/or 14 to paravascular tears (PVT) in the posterior pole. Thirty six eyes were phakic, 8 aphakic and 19 pseudophakic. Grade 0 or A PVR was present in 50 cases and grade B in the remaining Visual acuity improved from 1.7 logMar to 0.98 logMar (p ??0.0017). Reattachment rate was 73% after a single operation and 93.6% after subsequent procedures whatever the status of the lens. Among the 17 relapses, 8 cases (47%) received silicone oil tamponade. Success rate was comparable in the cryopexy group and in the laser photocoagulation group (76% vs. 60% p ??0,31) Axial length was greater in the failure group than in the success group (33.12mm vs. 31.7mm, p ??0.0168). Beyond 33.5mm, redetachment rate reached 50%. Tears larger than 3 optic disc diameter (ODD) were more frequent in the failure group than in the success group (29,4% versus 6,5%; p=?0.0278).

CONCLUSION:

Vitrectomy and fluid-gas exchange without scleral buckling enabled retinal reattachment in 73% eyes after a single operation. Risk factors for relapse were axial length over 33.5mm and tear larger than 3 ODD.