Minimalist pars plana vitrectomy repair favorable

Fort Lauderdale, FL-Simplification of pars plana vitrectomy (PPV) to repair primary rhegmatogenous retinal detachments means less is more.

"In the surgical repair of primary uncomplicated retinal detachment, scleral buckling continues to be the preferred approach to most young phakic eyes, whereas PPV has assumed an increasingly dominant role in other cases," said Dr. Johnson, professor and director of the Retina Service, Department of Ophthalmology and Visual Science, University of Michigan Kellogg Eye Center, Ann Arbor, MI.

Dr. Johnson and colleagues hypothesized that a very high, single-operation success rate should result with achievement of two intraoperative goals: first, elimination of dynamic vitreous traction by vitrectomy and second, identification and treatment of all retinal breaks.

If outcomes are similar, a simple procedure should always be chosen over a complex procedure, he said, because it avoids the cost and morbidity of unnecessary measures.

Dr. Johnson and his colleagues conducted a retrospective noncomparative study in which they analyzed the anatomic and functional outcomes of a consecutive series of primary and uncomplicated retinal detachment cases. The patients were treated with what he described as "a minimalist approach" of PPV alone without adjuvant procedures.

One surgeon performed all surgeries from January 2000 to January 2010. A total of 177 patients underwent PPV to treat a rhegmatogenous retinal detachment during the time frame of the study; 84 patients were excluded because of PVR, a previous vitreoretinal surgery, complex retinal detachments, giant retinal tears, less than 6 months of follow-up, and cytomegalovirus retinitis.

In all cases, 20- or 23-gauge vitrectomies were performed with a wide view of the retina. The vitreous skirt was trimmed with special attention to retinal breaks. However, extensive shaving with scleral depression was performed in only about one-third of cases.

Dr. Johnson emphasized that a meticulous search for all retinal breaks using the operating microscope and indirect ophthalmoscope is critical. All retinal breaks and all suspicious lesions are treated. He said he uses cryotherapy to treat most small anterior breaks and endolaser for any others. The normal retina is not treated prophylactically.

Endodrainage and C₃F₈ gas were used. Heavy liquid was used only for cases with excessive retinal mobility in two eyes and scleral buckling was not performed in any eyes, he said.