Vitrectomy for Macular Pucker with Prophylactic Peripheral Endolaser: Results of Our Experience


ABSTRACT

Aim:

Retinal detachment following macular surgery is an unfortunately well known and severe post-operative complication. The purpose of this presentation is to show our experience in the surgical technique with vitrectomy and prophylactic peripheral endolaser, in the treatment of idiopathic macular pucker. The aim of the study was to analyze the safety and the effectiveness of this technique in terms of incidence of post-operative retinal detachment (RRD), and/or other major complications (endophthalmitis and cystoid macular edema) and final best-corrected visual acuity (BCVA).

Methods:

A retrospective series of 72 consecutive patients treated with 23, 25 and 27 gauge vitrectomy was analysed. Under local or general anaesthesia, the surgical technique consisted in a standard via pars plana approach (PPV) with central and peripheral complete vitrectomy, induction of posterior vitreous detachment, if not present and an ERM/ILM peeling. The vitrectomy was assisted by the use of a single twenty seven gauge light chandelier placed at twelve o’clock. At the end of the procedure a peripheral 360 degrees, or limited (under the trocars), endolaser treatment was done. Finally, a partial final fluid-air exchange was performed before removing the trocars. If a concomitant cataract was present, a phacoemulsification with intraocular lens implant was associated to the vitreo-retinal procedure (F-PPV).

Results:

72 eyes were analyzed retrospectively: 49 PPV and 23 F-PPV. 29 eyes treated with 23 gauge, 25 with 25 gauge and 18 with 27 gauge system. The mean follow-up was 6-36 months (01.2010 – 05.2016). The mean pre-operative BCVA was 20/63 and the mean post-operative BCVA was 20/40. Preoperative central foveal thickness (CFT) was 460 µm and post-op CFT was 356 µm. Complications were 1 intraoperative RRD, 0 post-operative RRD and endophthalmitis were observed. In the post-operative period 8 eyes (5.76 %) developped a cystoid macular edema, not present at the baseline.

Conclusions:

The addition of peripheral laser treatment seems not interfere the functional results. The vitrectomy for macular pucker with a prophylactic peripheral endolaser treatment seems to be a safe (in terms of reduction of the incidence of post-op retinal detachment) and effective procedure in terms of improvement of visual acuity.


CONTACT DETAILS

Paolo Rossini
Ravenna, Italy
Email : paolorossini@hotmail.com
Work Phone: +390544203228