The use of panoramic viewing system in relaxing retinotomy and retinectomy

Retinotomies and retinectomies are surgical procedures mainly devoted to the peripheral retina that require optimal visibility and adequate magnification to make the surgeon's task easy, quick, and safe. The purpose of present study was to estimate to what extent the introduction of wide-angle viewing systems can help the surgeon perform safer and more effective retinotomy procedures.

The authors retrospectively analyzed the records of patients undergoing retinotomy procedures between 1993 and 1995 and divided them into two groups according to the viewing system used during the retinotomy procedures. Group 1 included 86 eyes that underwent surgery between July 1991 and June 1993 with Lander's plano-concave and prismatic lenses (Optikon, Rome, Italy), and group 2 included 96 eyes that underwent surgery between July 1993 and June 1995 with the Advanced Vitreoretinal Instruments system (New York, NY). Outcome measures were divided into preoperative (diagnosis at baseline, anterior proliferative vitreoretinopathy grade and extension, and visual acuity), intraoperative (size of retinotomy, number of laser spots, need for scleral depression, lensectomy, intraocular lens and capsule removal, and duration of treatment) and postoperative (anatomic success rates, visual acuity, postoperative intraocular pressure, and need for postoperative laser treatment and follow-up treatment).

Among preoperative parameters, there were no significant differences between the two groups. For intraoperative parameters, eyes in group 2 underwent significantly shorter surgical procedures, had less of a need for scleral depression, and, as a group, had a higher average number of laser spots. For postoperative parameters, eyes in group 2 had a significantly lower need for laser treatment at the edge of retinotomy after surgery.

Our results suggest that the use of a panoramic viewing system significantly decreases the time required for intervention, allowing more complete laser treatment along the edge of the retinotomy and lowering the need for scleral depression. The need for completion of laser treatment along the edge of the retinotomy after surgery also is reduced significantly, possibly increasing patient comfort because, especially in the early postoperative days, postoperative laser treatment can be extremely uncomfortable for the patient and difficult to perform for the surgeon. No prognostic benefit has been proven for any of the two groups because anatomic and visual results were overlapped.