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Twenty-three gauge vitrectomy may be used to treat rhegmatogenous retinal detachment
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 Vikram J. Setlur |
PHILADELPHIA — A smaller-gauge pars plana vitrectomy may be effective in achieving retinal reattachment, a presenter said here.
"Twenty-three-gauge primary vitrectomy for [retinal detachment] shows good primary reattachment rates over a 3-month follow-up period with minimum postop complications," Vikram J. Setlur, MD, said at the Wills Eye Institute Alumni Conference.
The retrospective study analyzed 79 eyes with rhegmatogenous retinal detachment who were treated using 23-gauge vitrectomy, endolaser and gas tamponade. Minimal follow-up time was 3 months.
"Smaller-gauge instrumentation has been rapidly adopted worldwide; however, the efficacy of small-gauge instrumentation for the repair of rhegmatogenous [retinal detachment] is currently not well known," Dr. Setlur said.
Patients who underwent a prior vitrectomy, had grade C or worse proliferative vitreoretinopathy, had silicone oil, or received scleral buckling at the time of vitrectomy were excluded.
Primary anatomical success occurred in 84% of eyes, while final anatomical success was achieved in all eyes. Mean follow-up was 9 months, and the median time to repair rhegmatogenous retinal detachment was 3 days. On average, patients reached attachment in 29 days.
Thirty-six eyes had macula-on rhegmatogenous retinal detachment, and Snellen visual acuity improved from 0.43 to 0.29 in these patients. For those with macula-off rhegmatogenous retinal detachment, vision improved from 2.00 to 0.68.
Detachment recurred in 7.6% of eyes due to new tears and 8.9% due to proliferative vitreoretinopathy. Ten eyes had postoperative epiretinal membrane, 14 showed elevated IOP and one experienced vitreous hemorrhage.
- Disclosure: Dr. Setlur reported no relevant financial relationships.
This nicely designed retrospective study demonstrates that 23-gauge vitrectomy can be used effectively to repair selected retinal detachments. How scleral buckling as an alternative technique or used in combination with vitrectomy compares to small-gauge vitrectomy alone remains to be clarified. This type of investigation is particularly important as we endeavor to select therapeutic options for eyes that maximize their likelihood of single surgery successful RD repair while minimizing their chance of complications and side effects.
– Julia A. Haller, MD
OSN Retina/Vitreous
Board Member
Disclosure: Dr. Haller has no financial interests to disclose.