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Three hundred and sixty degree retinotomy for retinal detachments with severe proliferative vitreoretinopathy
Steven Garnier1, Ahmed Rahmi, Cédric Grasswil
1Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.
Aims:
To assess the anatomic and functional results of 360° retinotomy for rhegmatogenous retinal detachment (RD) with severe proliferative vitreoretinopathy (PVR).
Materials And Methods:
Retrospective, non-comparative, interventional, case study of 20 consecutive patients. All surgical operations are as follows: vitrectomy, membrane peeling, PFCL, circumferential 360° retinotomy with anterior retinectomy, and silicone oil tamponade. The decision to pursue retinotomy was made during surgery after exploring all conventional techniques and after maximum membrane removal.
Results:
The mean number of previous interventions was 1.7 (median 2; range: 0-4). All retinas were reattached at the end of surgery. After 38 months of mean follow-up (range: 18-53 months) the complete retinal reattachment rate was 70 % (14/20). At the end of follow-up, four eyes (20 %) were enucleated and two patients are deceased. Silicone oil was removed in five eyes (25 %). Five eyes (25 %) developed corneal degeneration, four (20 %) rubeosis and one eye (5 %) presented an optic nerve atrophy. Final post-operative visual acuity in eyes with reattached retinas (n = 14) was better or equal to 20/200 in two cases, counting fingers in six cases , hand movements in five cases and light perception in one case.
Conclusions:
Only two of 20 operated eyes (10 %) had visual acuity better or equal to 20/200, but only four eyes (20 %) were enucleated. The aim of 360° retinotomy is to avoid further surgery on already fragile and multi-operated eyes.
