Journal List > J Korean Ophthalmol Soc > v.57(10) > 1010430

TOOLS
Lee, Kwon, Park, Park, Byon, and Lee: Prognostic Factors of Anatomical Success in Microincisional Vitrectomy for Rhegmatogenous Retinal Detachment
Original Article

J Korean Ophthalmol Soc 2016;57(10):1613-1618.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1613

Prognostic Factors of Anatomical Success in Microincisional Vitrectomy for Rhegmatogenous Retinal Detachment

Seok Jae Lee, MD1, Han Jo Kwon, MD1, Kang Yoon Park, MD1, Sung Who Park, MD1, 2, Ik Soo Byon, MD1, 3, Ji Eun Lee, MD1, 2

1Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea

2Medical Research Institute, Pusan National University Hospital, Busan, Korea

3Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Address reprint requests to Sung Who Park, MD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7326, Fax: 82-51-240-7341 E-mail: oph97@naver.com

Received 23 June 2016       Accepted 18 September 2016

Copyright © 2016 Korean Ophthalmological Society

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 determine the prognostic factors of primary anatomical success after microincisional vitrectomy for rhegmatogenous retinal detachment (RRD).

Methods

The medical records of 206 eyes treated with microincisional vitrectomy for RRD from 2009 to 2014 were retrospectively reviewed. The preoperative factors (best corrected visual acuity, break sites, number of breaks, break size, extent of retinal detachment, high myopia, lens status) and intraoperative factors (combined cataract surgery, vitrectomy machine, tamponade, sclerotomy size) were investigated to determine correlations with primary anatomical success.

Results

Of the 206 eyes, 198 eyes (96.1%) were reattached after primary vitrectomy; 46 eyes of 48 eyes with inferior breaks (95.8%, p = 1.000), 42 eyes of 44 pseudophakic eyes (95.5%, p = 1.000), 84 eyes of 89 eyes with multiple breaks (95.4%, p = 0.296). All 39 eyes using air tamponade (100%, p = 0.224) were reattached and there was no significant correlation with primary anatomical success. Conversely, 44 eyes of 49 eyes with high myopia (89.8%) were reattached after primary surgery, which was lower than non-high myopic eyes (98.1%, p = 0.028). Multivariate logistic regression showed that high myopia was an independent factor for primary reattachment failure (odds ratio = 5.795, 95% confidence interval = 1.332–25.208, p = 0.019).

Conclusions

Microincisional vitrectomy for RRD showed a high reattachment rate regardless of break site and number, lens status, or tamponade type. However, primary reattachment failure was relatively common in high myopia patients, thus, meticulous care is required.

Keywords: Pars plana vitrectomy, Prognosis, Rhegmatogenous retinal detachment

References

1. Woon WH, Burdon MA, Green WT, Chignell AH. Comparison of pars plana vitrectomy and scleral buckling for uncomplicated abdominal retinal detachment. Curr Opin Ophthalmol. 1995; 6:76–9.
2. Bartz-Schmidt KU, Kirchhof B, Heimann K. Primary vitrectomy for pseudophakic retinal detachment. Br J Ophthalmol. 1996; 80:346–9.
crossref
3. Newman DK, Burton RL. Primary vitrectomy for pseudophakic and aphakic retinal detachments. Eye (Lond). 1999; 13(Pt 5):635–9.
crossref
4. Wickham L, Connor M, Aylward GW. Vitrectomy and gas for abdominal break retinal detachments: are the results comparable to abdominal, gas, and scleral buckle? Br J Opthalmol. 2004; 88:1376–9.
5. Gartry DS, Chignell AH, Franks WA, Wong D. Pars plana abdominal for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol. 1993; 77:199–203.
6. Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary pars plana vitrectomy versus scleral buckle surgery for the abdominal of pseudophakic retinal detachment: a randomized clinical trial. Retina. 2005; 25:957–64.
7. Park HJ, Seo MS. Clinical analysis according to treatment methods in simple retinal detachment. J Korean Ophthalmol Soc. 2001; 42:1277–83.
8. Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in abdominal retinal detachment. Acta Ophthalmol Scand. 2005; 83:293–7.
9. Koh TH, Choi MJ, Cho SW, et al. Scleral buckling and primary abdominal in simple rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2010; 51:366–71.
10. Martínez-Castillo VJ, García-Arumí J, Boixadera A. Pars plana abdominal alone for the management of pseudophakic abdominal retinal detachment with only inferior breaks. Ophthalmology. 2016; 123:1563–9.
11. Schneider EW, Geraets RL, Johnson MW. Pars plana vitrectomy without adjuvant procedures for repair of primary rhegmatogenous retinal detachment. Retina. 2012; 32:213–9.
crossref
12. Park SW, Kwon HJ, Kim HY, et al. Comparison of scleral buckling and vitrectomy using wide angle viewing system for abdominal retinal detachment in patients older than 35 years. BMC Ophthalmol. 2015; 15:121.
crossref
13. Zhou C, Qiu Q, Zheng Z. Air versus gas tamponade in abdominal retinal detachment with inferior breaks after 23-gauge pars plana vitrectomy: a prospective, randomized comparative interventional study. Retina. 2015; 35:886–91.
14. Sinawat S, Ratanapakorn T, Sanguansak T, et al. Air vs perfluoropropane gas in pneumatic retinopexy: a randomized non-inferiority trial. Arch Ophthalmol. 2010; 128:1243–7.
15. Tan HS, Oberstein SY, Mura M, Bijl HM. Air versus gas abdominal in retinal detachment surgery. Br J Ophthalmol. 2013; 97:80–2.
16. Sharma A, Grigoropoulos V, Williamson TH. Management of abdominal rhegmatogenous retinal detachment with inferior breaks. Br J Ophthalmol. 2004; 88:1372–5.
17. Heimann H, Bornfeld N, Friedrichs W, et al. Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1996; 234:561–8.
crossref
18. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.
crossref
19. Nam Y, Chung H, Lee JY, et al. Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases. Eye (Lond). 2010; 24:869–74.
crossref
20. Miller DM, Riemann CD, Foster RE, Petersen MR. Primary repair of retinal detachment with 25-gauge pars plana vitrectomy. Retina. 2008; 28:931–6.
crossref
21. Lee YH, Park JH, Sagong M, Chang WH. Surgical outcomes of transconjunctival 25-gauge plus pars plana vitrectomy for abdominal retinal detachment. J Korean Opthalmol Soc. 2015; 56:351–6.
22. Park SW, Kwon HJ, Shin MK, et al. Impact of age on scleral abdominal surgery for rhegmatogenous retinal detachment. J Korean Ophthalmol 2017. [In press].

Table 1.
Baseline characteristics
  Patients
Number of Eyes 206
Age (year) 56.4 ± 10.8
Male:Female 130:76
Right:Left 64:142
Best corrective visual acuity (log MAR) 1.40 ± 1.06
Axial length (mm) 24.991 ± 1.963
Macula on:off 67:139
Lens status at surgery (phakic:pseudophakic) 162:44
Site of retinal breaks (Superior:Middle:Inferior) 126:32:48
Number of retinal breaks 1.8 ± 1.3
Size of retinal breaks (disc diameter) 1.62 ± 1.26
Extent of retinal detachment (hour) 4.96 ± 2.04

Values are presented as mean ± SD unless otherwise indicated.

Table 2.
Operative methods
  Patients
Combined with cataract surgery 146/162 (90.1)
Tamponade  
   SF6 111 (53.9)
   C3 F8 43 (20.9)
   Room air 39 (18.9)
   Silicone oil 13 (6.3)
Incision size (gauge)  
   23 153 (74.3)
   25 53 (25.7)
Vitrectomy machine  
   ACCURUS® 127 (61.7)
   Constillation® 79 (38.3)

Values are presented as n (%).

Table 3.
Correlation between variables with primary reattachment rate
  Success Fail p-value
Gender     0.451*
   Male 131 (97.0) 4 (3.0)  
   Female 67 (94.3) 4 (5.7)  
BCVA at first visit (log MAR)     1.000*
   <1.40 100 (96.1) 4 (3.9)  
   ≥1.40 98 (96.1) 4 (3.9)  
Macula status     0.241*
   Off 132 (95.0) 7 (5.0)  
   On 66 (98.5) 1 (1.5)  
Lens     0.569*
   Phakic 156 (96.3) 6 (3.7)  
   Pseudophakic 42 (95.5) 2 (4.5)  
High myopia     0.028*
   No (<26 mm) 154 (98.1) 3 (1.9)  
   Yes (≥26 mm) 44 (89.8) 5 (10.2)  
Number of breaks     0.519*
   <2 114 (97.4) 3 (2.6)  
   ≥2 84 (94.4) 5 (5.6)  
Site of breaks     0.292*
   Other than no Inferior breaks 152 (96.2) 6 (3.8)  
   Inferior breaks 46 (95.8) 2 (4.2)  
Gauge     0.962*
   23 147 (96.1) 6 (3.9)  
   25 51 (96.2) 2 (3.8)  
Equipment     0.960*
   ACCURUS® 122 (96.1) 5 (3.9)  
   Constillation® 76 (96.2) 3 (3.8)  
Tamponade     0.137†
   Air 39 (100.0) 0 (0.0)  
   Gas 147 (95.5) 7 (4.5)  
   Silicone oil 12 (92.3) 1 (7.7)  

Values are presented as n (%).

BCVA = best corrected visual acuity.

* Chi-squre test

† Linear by linear association.

Table 4.
Multivariate logistic regression of risk factors for surgery success
  OR 95% CI p-value
High myopia (no vs. yes) 5.79 1.33 to 25.21 0.019

OR = odds ratio; CI = confidence interval.

TOOLS
Similar articles