Innovative technologies in vitreo-retinal surgery for rhegmatogenous retinal detachment

Abstract

Vitreo-retinal surgery techniques have significantly improved over time and increased the success rates in the surgery of Rhegmatogenous Retinal Detachment (RRD). The purpose of this study is to evaluate the results of the primary vitrectomy for RRD. We have conducted a retrospective study on all the RRD cases that we have operated on by pars plana vitrectomy between October 2009 – October 2010 (70 cases). The description of the surgical techniques concerns the vitrectomy itself and the associated maneuvers: drainage of the subretinal fluid, retinopexy (endolaser/exocryo), internal tamponade. The peroperative complications are presented and the results are evaluated 3 months after surgery as: success, simple recurrence, Proliferative Vitreo-Retinopathy (PVR), Cystoid Macular Edema (CME). All the posterior vitrectomies have been performed with the Accurus machine (Alcon). We used the 20 gauge system and a high speed vitrectomy probe (2500 cuts/minute). The vitrectomy has been as complete as possible in all situations, up to the vitreous base. The subretinal fluid has been drained by PerFluoroCarbon Liquids (PFCL) injection in 65 cases (92.85%) or by fluid/air exchange in the remaining 5 cases (7.14%). The retinopexy has been performed with a cryoprobe in 46 cases (65.71%) and with the endolaser fiber in 24 cases (34.28%). The endolaser cerclage has been associated in 26 cases (37.14%) and we used the silicone oil for the internal tamponade in all the situations. We have accidentally injured the retina in 5 cases (7.14%) and touched the lens in 4 cases (5.71%). Success has been achieved in 58 cases (82.85%), simple recurrence has been identified in 8 cases (11.42%), PVR in 3 cases (4.28%), CME in one case (1.42%). The technical advances are emphasized (high-speed cutting rate, 3D system), with implications in the surgery of RRD. The modern vitrectomy techniques have proven their efficacy in the treatment of RRD.