Primary Repair of Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy

Seung Kook Baek; Young Hoon Lee

doi:10.3341/jkos.2015.56.1.55

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Baek and Lee: Primary Repair of Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy

Original Article

J Korean Ophthalmol Soc 2015;56(1):55-61.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.1.55

Primary Repair of Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy

Seung Kook Baek, MD¹, Young Hoon Lee, MD^1,^2,

¹Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

²Konyang University Myunggok Medical Research Institute, Daejeon, Korea

Address reprint requests to Young Hoon Lee, MD, Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 302-812, Korea, Tel: 82-42-600-9258, Fax: 82-42-600-9251 E-mail: astrix001@gmail.com

Received 14 March 201417 June 2014 Accepted 20 December 2014

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 25-gauge transconjunctival sutureless vitrectomy for primary repair of rhegmatogenous retinal detach-ment (RRD).

Methods

We performed a retrospective study of 46 consecutive eyes of 46 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary RRD. Outcome measures included single surgery anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications.

Results

Forty eyes were phakic and six eyes were pseudophakic. Twenty-six eyes had superior quadrant retinal tear, 12 eyes had inferior quadrant tear and eight eyes had both. The mean operation time was 56.3 minutes. The single surgery anatomical success rate was 93.48% (43/46). Two eyes with recurrent retinal detachment underwent fluid gas exchange: one received barrier laser treatment in the outpatient clinic, and the other underwent reoperation; the final success rate was 100%. The best corrected visual acuity improved from 1.34 log MAR to 0.48 log MAR (p < 0.01) in macula - off patients (30 eyes) and from 0.32 log MAR to 0.07 log MAR (p = 0.279) in macula - on patients (16 eyes). Postoperative complications included wound leaking (two eyes), cataract progression (13 eyes), vitreous hemorrhage (one eye), transient hypotony (one eye), and increased intraocular pressure (seven eyes).

Conclusions

Primary repair of RRD using 25-gauge transconjunctival vitrectomy resulted in an excellent final anatomical success rate and postoperative visual outcomes.

Keywords: Rhegmatogenous retinal detachment, Twenty five-gauge transconjunctival sutureless vitrectomy

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Table 1.

Demographics and baseline characteristics for 46 eyes of 46 patients

Parameters or factors	No. (%)
Operated eye (n)
Right	28 (60.87)
Left	18 (39.13)
Sex (n)
Male	26 (56.52)
Female	20 (43.48)
Mean age ± SD (years)	53.36 ± 16.8
Mean follow up ± SD (months)	4.5 ± 2.52
Mean axial length (mm)	25.05 ± 2.2
Mean operation time (minutes)	56.3 ± 17.89
Mean duration of hospital stay after surger	ry (days) 3.17 ± 1.55
Reasons for redetachment (n)
PVR	1 (2.17)
New retinal break(s)	0
Open old retinal break(s)	2 (4.35)
Primary success	43/46 (93.48)
Final anatomical success	46/46 (100)

SD = standard deviation; PVR = proliferative vitreoretinopathy.

Table 2.

Intraoperative factors and primary success

Factors	No. (%)	No. (%) of primary success	p-value
Preoperative macula status (n, %)
Macula on	16 (34.78)	15 (32.61)	0.957^∗
Macula off	30 (65.22)	28 (60.87)
Preoperative lens status (n, %)
Phakic	40 (86.96)	37 (80.43)	0.488^∗
Pseudophakic	6 (13.04)	6 (13.04)
Operative method (n, %)
Vitrectomy only	33 (71.74)	31 (67.39)	0.840^∗
Vitrectomy with cataract operation	13 (28.26)	12 (26.09)
Number of breaks (n, %)
1	20 (43.48)	19 (41.30)	0.751^∗
2	18 (39.13)	17 (36.96)
>2	8 (17.39)	7 (15.22)
Location of primary tears (n, %)
Superior quadrant (9-3 o’clock)	26 (56.52)	24 (52.17)	0.505^∗
Inferior quadrant (4-8 o’clock)	12 (26.09)	12 (26.09)
Both quadrant	8 (17.39)	7 (15.22)
Laser
Focal	33 (71.74)	32 (69.57)	0.127^∗
360’	13 (28.26)	11 (23.91)
Tamponade
Silicone oil	3 (6.52)	3 (6.52)	0.858^∗
C₃ F₈	42 (91.30)	39 (82.61)
Air	1 (2.18)	1 (2.18)

^∗ Statistics were analyzed by Chi-Square test.

Table 3.

Mean value of visual acuity and outcomes

Macula on (16 eyes)	Preoperative VA (log MAR) 0.32 ± 0.61 (0.71 ± 0.34)	Postoperative VA (log MAR) 0.07 ± 0.13 (0.89 ± 0.21)	p-value 0.07^∗
Macula off (30 eyes)	1.34 ± 0.64 (0.11 ± 0.17)	0.48 ± 0.41 (0.43 ± 0.24)	<0.01^†
Total (46 eyes)	0.59 ± 0.32 (0.32 ± 0.38)	0.34 ± 0.39 (0.98 ± 0.79)	<0.01^†

Values are presented as mean ± SD. VA = visual acuity.

^∗ Wilcoxon signed rank test

^† Paired t-test.

Table 4.

Intraoperative and postoperative complications

Complications	Number of eyes
Sclerotomy site leakage	2
Cataract progression	13
Feathery opacity	4
IOL decentration	0
Hypotony^∗	1
Secondary glaucoma	7
ERM	1
Vitreous hemorrhage	1
Endophthalmitis	0
Redetachment	3

IOL = intraocular lens; IOP = intraocular pressure; ERM = epiretinal membrane.

^∗ Intraocular pressure < 5 mm Hg.

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