Scientific programm: Abstract

4th scientific session: Follow ups on Strategies

25. Primary Pars Plana Vitrectomy with or without
      Scleral Buckling for Rhegmatogenous Retinal
      Detachment: Does Gauge Matter?

Colin A. McCannel (Los Angeles)

Background: To report the anatomic and visual outcomes of 20-, 23-, and 25-gauge vitrectomy with or without scleral buckle for repair primary rhegmatogenous retinal detachment.
Methods: The study design is a retrospective, consecutive, case series. We identified and reviewed all cases of vitrectomy for retinal detachment. Major inclusion criteria for the study were no previous vitrectomy or surgery for retinal reattachment, a minimum of 3 months follow up, and absence of grade C or worse proliferative vitreoretinopathy (PVR). Demographic, ocular, retinal detachment and outcome characteristics were recorded for analysis. For subgroup analysis cases were categorized by surgical gauge of instrumentation and by concomitant use of scleral buckling.
Results: Inclusion criteria were met by 119 cases among 116 patients. Mean follow-up time was 9.0 months (range, 3.0 to 30.5 months). Overall retinal reattachment with a single operation was achieved in 92.4% (110 of 119 eyes). Among the nine initial surgery failures, the retina was reattached with one (8 cases), or two (1 case) reoperations. The primary success rate among 20-gauge cases was 92.8% (77 of 83 eyes); 23-gauge cases, 90.9% (10 of 11 eyes); and 25-gauge cases,92.0% (23 of 25 eyes).  Overall, preoperative characteristics associated with primary surgery failure were presence of PVR and phakic status.
Conclusions: Pars plana vitrectomy, with or without scleral buckle, is effective for repairing primary rhegmatogenous retinal detachment with high single surgery anatomic and final success rates. While instrumentation gauge did not affect the success rate, phakic lens status and presence of PVR were associated with primary surgery failure.

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