Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

Seong Chan Choi; Han Joo Cho; Dong Won Lee; Sung Won Cho; Tae Gon Lee; Chul Gu Kim; Jong Woo Kim; Hyoung Seok Kim

doi:10.3341/jkos.2015.56.6.900

Journal List > J Korean Ophthalmol Soc > v.56(6) > 1010303

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Choi, Cho, Lee, Cho, Lee, Kim, Kim, and Kim: Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

Original Article

J Korean Ophthalmol Soc 2015;56(6):900-905.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.900

Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

Seong Chan Choi, MD, Han Joo Cho, MD, Dong Won Lee, MD, Sung Won Cho, MD, Tae Gon Lee, MD, Chul Gu Kim, MD, Jong Woo Kim, MD, Hyoung Seok Kim, MD

Myunggok Eye Research Institute, Department of Ophthalmology, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Hyoung Seok Kim, MD Kim’s Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 150-034, Korea, Tel: 82-2-2639-7811, Fax: 82-2-2671-6359 E-mail: burnlife@kimeye.com

Received 5 December 201431 December 2014 Accepted 12 May 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 report the outcomes of relaxing retinectomy for retinal detachment in patients with proliferative vitreoretinopathy (PVR).

Methods

Sixty-four cases of relaxing retinectomy for PVR with a minimum follow-up of 6 months were retrospectively reviewed. The outcomes included achievement of complete retinal reattachment, PVR recurrence, the mean number of additional oper-ations, visual acuity and incidence of postoperative complications. We analyzed the influence of intraoperative factors including lens status, retinectomy extent, additional scleral buckling, and tamponade agent on primary retinal reattachment.

Results

Complete retinal reattachment was achieved in 47 eyes (74.3%) without an additional surgery. PVR recurred in 19 eyes (29.7%) and an additional operation was performed in 17 eyes (26.6%). Fifty-seven (89.1%) eyes showed complete retinal reattachment and 40 eyes (62.5%) had visual acuity of 0.02 or more at the final follow-up visit. Hypotony was the major complication and developed in 10 eyes (15.6%). Eyes undergoing smaller (< 180˚) retinectomy or silicone oil tamponade had higher primary anatomical success rates than larger (≥ 180˚) retinectomy or gas tamponade (p = 0.043 and 0.013, respectively).

Conclusions

Relaxing retinectomy is a useful technique for retinal detachment with PVR, but risk of recurrent proliferation or hypotony should be considered.

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Keywords: Hypotony, PVR, RD, Relaxing, Retinectomy

References

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Figure 1.

Consecutive fundus photos of a 25 year old male patient undergoing 5 repeated operations. (A) Total retinal detachment with extensive subretinal proliferation before surgery. (B) Re-attached retina 2 weeks after 360° relaxing retinectomy (the second operation). (C) Initiation of reproliferation at retinectomy margin 3 weeks after second operation. (D) Preretinal reproliferation 2 weeks after fourth operation. (E) Matured preretinal membrane 4 weeks after fourth operation. (F) Remained tough fibrous ring surrounding the retinectomy site after fifth operation.

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Table 1.

Baseline characteristics of patients undergoing relaxing retinectomy for proliferative vitreoretinopathy

Mean age (years, range)	54.6 ± 18.8 (12-78)
Mean follow-up (months, range)	17 ± 12 (6-42)
Gender
Male	38 (59.4)
Female	26 (40.6)
Best corrected visual acuity (Snellen)
≥0.1	8 (12.5)
0.02-<0.1	31 (48.4)
<0.02	25 (39.0)
Prior operation
Mean number	1.75 ± 0.31
No prior operation	15 (23.4)
Scleral buckling or encircling	37 (57.8)
Vitrectomy	38 (59.4)
Lens status
Phakic	25 (39.0)
Pseudophakic	35 (54.7)
Aphakic	4 (6.3)

Values are presented as mean ± SD or n (%) unless otherwise indicated.

Table 2.

Surgical details of relaxing retinectomy for proliferative vitreoretinopathy

Retinectomy extent
<90˚	8 (12.5)
90˚-<180˚	12 (18.8)
180˚-<270˚	19 (29.7)
270˚-<360˚	7 (10.9)
360˚	18 (28.2)
Retinectomy center location (excluding 360˚ cases)
Inferior	42 (91.3)
Superior	4 (8.7)
Intraoperative scleral buckling or encircling	12 (18.8)
Intraoperative lens removal
Phacoemulsification	10 (15.6)
Pars plana lensectomy	3 (4.7)
Tamponade type
Silicone oil	51 (79.7)
Gas	13 (20.3)

Values are presented as n (%).

Table 3.

Outcomes at final follow-up visit

Anatomical attachment	57 (89.1)
Recurrent proliferative vitreoretinopathy	19 (29.7)
Number of reoperation
0	47 (73.4)
1	10 (15.6)
≥2	7 (10.9)
Intraocular pressure (mm Hg)
≥22	12 (18.8)
6-21	42 (65.6)
≤5	10 (15.6)
Best corrected visual acuity (Snellen)
≥0.1	19 (29.7)
0.02-<0.1	21 (32.8)
<0.02	24 (37.5)

Values are presented as n (%).

Table 4.

Factors predictive of primary anatomical success

	Number (%)	Primary anatomical reattachment (%)	p-value^*
Lens status			0.556
Phakia	12 (18.8)	8 (66.7)
Pseudophakia or aphakia	52 (81.3)	39 (75.0)
Retinectomy extent			0.043
<180˚	20 (31.3)	18 (90.0)
180-360˚	44 (68.8)	29 (65.9)
Additional scleral buckling or encircling			0.497
Yes	49 (76.6)	37 (75.5)
No	15 (23.4)	10 (66.7)
Tamponade type			0.013
Silicone oil	51 (79.7)	41 (80.4)
Gas	13 (20.3)	6 (46.2)

^* Pearson’s chi-square test.

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