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Published on: January 25, 2019
Influence of relaxing retinotomy on surgical outcomes in proliferative vitreoretinopathy
Joseph J Tseng1, Gaetano R Barile, William M Schiff
1Department of Ophthalmology, Columbia University College of Physicians & Surgeons, New York, New York, USA.
Purpose:
This study sought to determine the influence of relaxing retinotomy (RR) incisions upon surgical outcomes in the repair of recurrent retinal detachment (RD) attributable to proliferative vitreoretinopathy (PVR).
Design:
Retrospective, consecutive, nonrandomized, single-center series.
Methods:
Eighty-one eyes with recurrent RD attributable to PVR were retrospectively reviewed. Exclusion criteria were giant retinal tear, uveitis, trauma, proliferative diabetic retinopathy, and age under 18 years. A total of 52 eyes underwent RR at the time of surgery (64.2%); 29 eyes were repaired without this technique. Perfluorocarbon gas (n = 34) or silicone oil (n = 47) was used as postoperative tamponade. Statistical analyses were performed using the Fisher exact test.
Results:
Eyes that received RR had significantly higher rates of anterior PVR (P = .009). Eyes receiving silicone oil for postoperative tamponade had worse baseline characteristics compared with those receiving gas. The use of RR in eyes receiving gas tamponade had no marked influence on the initial anatomic outcomes, with recurrent retinal detachment occurring in five of 14 eyes that received an RR and seven of 20 eyes that did not receive an RR (P = .62). Eyes in which silicone oil was used as a postoperative tamponade had a significantly lower rate of recurrent RD requiring additional surgery when RR was employed (one of 38 eyes) when compared with eyes that did not receive an RR (three of nine eyes, P = .02). Ultimately, surgical reattachment was attained in all eyes except one. Eyes that received gas tamponade without RR had significantly better median vision (P = .008).
Conclusions:
Surgical management of PVR often results in ultimate retinal reattachment. An RR incision does not appear to influence initial anatomic repair when gas tamponade is used after vitrectomy surgery for PVR. However, RR may increase the initial surgical success rate in eyes receiving silicone oil tamponade for PVR. In eyes undergoing RR for the treatment of severe PVR, the use of silicone oil may increase the initial rate of reattachment compared with the use of gas tamponade.