Primary Vitrectomy Without Buckling for Rhegmatogenous Retinal Detachment: Failure Analysis and Its Causes Over 195 Consecutive Cases


Over the last ten years there has been a trend towards the treatment of Reghmatogenous Retinal Detachments (RRDs) with vitrectomy without buckling, as the primary procedure. Supported by numerous publications the addition of an encircling buckle at the initial surgery seems not to be useful. Nevertheless, many times we feel more confident by combining vitrectomy with a 360 degrees buckling in some cases, like detachments with inferior breaks or pseudophakic patients, in which we consider this could enhance our results, but without knowing if this really makes a difference. We decided to analyze our surgical results over 195 consecutive cases of RRDs treated with primary vitrectomy without bucklng, in not previously operated eyes, except cataract surgery. We included phakic, pseudophakic, or aphakic patients with RRDs and PVR equal or less than C2 (posterior). Patients with severe PVR or anterior vitreous base contraction were excluded. We also did not include patients with small retinogenic or atrophic holes because we consider this type of lesions should be treated only with scleral buckling. A 23G Pars Plana Vitrectomy was performed in every case, with meticulous 360 degrees vitreous base shaving under indentation. Perfluorocarbon liquid injection, endolaser sometimes combined with cryopexy around the breaks, fluid air exchange and 20% SF6 endotamponade completed the procedure. Every patient had at least a 4 months follow-up. Beyond our single operation success rate, that is comparable to other published series, we studied patients in which the detachment recurred after the initial surgery in order to find common features that may help us in individualizing eyes at higher risk for re-detachment. Thus in the future, the recognition of some preoperative characteristics at the initial presentation of the disease could serve us to evaluate if some special measures should be applied in these particular cases in order to lower the recurrence rate of the detachment.



Mariano Iros
Cordoba, Argentina
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