Anatomical and functional results of primary pars plana vitrectomy in rhegmatogenous retinal detachment

It was the aim of this retrospective study to analyse the anatomical success rate and functional outcome of patients with rhegmatogenous retinal detachments treated primarily by pars plana vitrectomy (PPV).

157 of 200 eyes (79%, 89 phakic (57%), 67 pseudophakic (43%), 1 aphakic) with rhegmatogenous retinal detachment were treated by primary pars plana vitrectomy. 132 cases (84%) completed 6 months, 131 (83%) 12 months, and 108 cases (69%) 24 months of follow-up. Selection of surgical methods was guided by recommendations from the SPR study. Different from these recommendations, phakic eyes were treated by primary PPV if the chance of successful scleral buckling was estimated to be < 90%.

Initial retinal attachment was achieved in all eyes. In 4 eyes peripheral tractional detachment presented during silicon removal. A second surgical intervention for the treatment of re-detachment became necessary in 8 eyes during follow-up. The rate of permanent single-intervention (except silicon removal) attachment was 92.4%. Finally the retina was completely attached in all eyes. Visual acuity improved from a preoperative level of logMAR 1.01 to 0.48 at month 6, 0.40 at month 12 and 0.33 at month 24. Mean final visual acuity at month 24 was 0.32 in phakic eyes and 0.35 in pseudophakic eye (difference not significant). Significant differences in visual acuity were found in relation to the preoperative status of the fovea.

The results of this case series, together with the previous published outcome of a cohort treated in the identical study period by scleral buckling, indicate that the outcome of retinal detachment surgery in an average cohort of patients can be expected to be much better than suggested by results of the SPR study.