Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

Dong Hyun Lee; Kyong Ho Kim; Sung Who Park; Ik Soo Byon; Ji Eun Lee

doi:10.3341/jkos.2015.56.12.1880

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Lee, Kim, Park, Byon, and Lee: Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

Original Article

J Korean Ophthalmol Soc 2015;56(12):1880-1886.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1880

Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

Dong Hyun Lee, M.D¹, Kyong Ho Kim, M.D^1,², Sung Who Park, M.D³, Ik Soo Byon, M.D^1,^2,^4,, Ji Eun Lee, M.D, PhD^3,⁴

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

³Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

⁴Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Ik Soo Byon, MD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup,Yangsan 50612, Korea Tel: 82-55-360-2131, Fax: 82-55-360-2161 E-mail: isbyon@naver.com

Received 17 April 20153 July 2015 Accepted 22 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid.

Methods

Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intra-ocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, lo-cation and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed.

Results

Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular sur-gery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92).

Conclusions

When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without pro-liferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.

Keywords: Encircling, Giant retinal tear, Perfluorocarbon liquid, Retinal detachment, Vitrectomy

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Figure 1.

Fundus photographs before and after retinal detachment repair. (A) Giant retinal tear is found from 2’30” to 6’ o’clock with retinal detachment with fovea off at baseline. (B) 6 months after removal of intraocular tamponade, retinal re-attachment is maintained.

Figure 2.

Correlations between best corrected visual acuity (BCVA) at the baseline and BCVA at the last follow-up. There is a significant correlation between baseline BCVA and post-operative BCVA at the last follow-up (r = 0.467, p = 0.001).

Table 1.

Baseline characteristics of the patients

Parameter	Vitrectomy only (n = 8)	Vitrectomy + encircling (n = 21)	p-value
Mean age (years)	49.0 ± 5.0	38.1 ± 14.5	0.316^*
Baseline BCVA (log MAR)	1.55 ± 1.22	1.70 ± 1.04	0.843^*
Axial length (mm)	27.1 ± 3.9	25.9 ± 2.2	0.443^*
IOP (mm Hg)	11.2 ± 6.3	11.0 ± 4.6	0.524^*
Lens status	0.433^†
Phakia	4 (50.0%)	15 (71.4%)
Psuedophakia	4 (50.0%)	6 (28.6%)
Previous ocular surgery	5 (62.5%)	8 (38.1%)	0.233^†
Atopic dermatitis	0 (0%)	2 (9.5%)	0.497^†
High myopia	3 (37.5%)	10 (47.6%)	1.000^†
Ocular trauma	1 (12.5%)	6 (28.6%)	0.283^†
Time from symptom onset to surgery (days)	8.5 ± 5.82	10.1 ± 7.65	0.895^*

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; IOP = intraocular pressure.^* Mann Whitney U-test; ^† Fisher’s Exact test.

Table 2.

Baseline characteristics of retinal detachment with giant retinal tears

Parameter	Vitrectomy only (n = 8)	Vitrectomy + encircling (n = 21)	p-value^*
Degree of tear			0.210
90-120 degree	4 (50.0)	10 (47.6)
120-180 degree	3 (37.5)	8 (38.1)
>180 degree	1 (12.5)	3 (14.3)
Location of tear	1.000
Superior	6 (75.0)	17 (81.0)
Inferior	2 (25.0)	4 (19.0)
Fovel detachment	2 (25.0)	7 (33.3)	1.000
Area of retinal detachment	0.167
1/4-2/4	3 (37.5)	7 (33.3)
2/4-3/4	5 (62.5)	9 (42.9)
3/4-4/4	0 (0)	5 (23.8)
Saved lens	2/4 (50)	7/15 (46.7)	0.216

Values are presented as n (%) unless otherwise indicated. ^* Fisher’s Exact test.

Table 3.

Anatomical success and change of BCVA

	Vitrectomy only	Vitrectomy + encircling	p-value
Primary anatomical success	7 (87.5%)	18 (85.7%)	1.000^*
Final anatomical success	8 (100.0%)	20 (95.2%)	0.483^*
Preoperative BCVA (log MAR)	1.55 ± 1.22	1.70 ± 1.04	0.843^*
Postoperative BCVA (log MAR)	0.80 ± 0.95	0.92 ± 0.33	0.076^†

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity.^* Fisher’s Exact test; † Mann-Whitney U-test.

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