Jean-Paul Berrod, I. Hubert, R. Ouled-Moussa, M. Casillas (Nancy, France)

Advantages:

Primary pars plana vitrectomy (P.P.V) is nowadays a common practice to repair retinal detachments in pseudophakic or phakic patients. It reduces periocular and muscle disorders, facilitates visualization of the breaks, and shortens surgical time. The technique was presented at the EVRS meeting in Biarritz in 2001 with excellent initial results of 92% reattachment rate at first procedure and almost 100% with subsequent surgery. This report on results ten years later, also to discusses indications about patients operated on from January 2008 through December 2009.

Methods:

Retrospective clinical trial including 234 consecutive eyes with 6 months follow up. Patients underwent 20 or 23-gauge P.P.V with simultaneous phacoemulsification of the lens in 50 % of phakic eyes, retinal reattachment with fluid-gaz exchange, cryo or laser retinopexy of the breaks and endotamponade with 25% SF6/air mixture. Preoperatively 55 % of the eyes were pseudophakic and PVR was superior to grade A in 13% eyes. Maculae were off in 66% of the eyes and mean extent of RD was 2.7 quadrants.

Effectiveness / Safety:

Postoperatively retinae were reattached with one operation in 83% of the eyes and in 95 % with subsequent surgery. Among 40 initial failures 18 were secondary to PVR and 25 to new breaks. At the end of follow up 91% of retinae were flat without silicon oil.

Take home message:

Primary PPV was an effective method to repair RD whatever the status of the lens especially in cases of posterior or multiple breaks difficult to indent. Ten years of experience shows that primary success rate remained under 85% and that 91% of the retina were finally reattached without permanent silicone tamponade.