JAN 07, 2020
This retrospective study describes the outcomes of small-gauge pars plana vitrectomy (PPV) for treating rhegmatogenous retinal detachment (RD) without scleral-depressed shaving of the vitreous base.
The study included 312 eyes (301 patients) undergoing small-gauge PPV for repair of rhegmatogenous RD. The surgical technique included 27-gauge (n=10), 25-gauge (n=10) and 23-gauge (n=199) PPV cases. All surgeries were performed using a wide-angle viewing system without scleral-depressed vitreous base shaving. No cases were excluded based on detachment complexity.
The average follow-up was 23 months. All cases had circumferential endolaser; 106 eyes received a concomitant scleral buckle. The single operation success rate was 95% and overall, final reattachment was achieved in 99% of eyes. By the last follow-up, 54% of eyes had a BCVA of 20/40 or better.
The primary limitation is the study’s retrospective nature with potential bias in case selection and reporting. For example, the authors excluded patients with less than 3 months of follow-up. It is possible that some of these cases may have redetached and received treatment elsewhere. About one-third of cases had concomitant scleral buckling, which may have helped support the vitreous base, therefore making shaving less important. All cases were performed by one surgeon which may limit the generalizability of these findings.
The importance of shaving the vitreous base during RD repair has often been emphasized during physician training. We have been taught that the vitreous is our enemy and we must remove it to prevent proliferative vitreoretinopathy and recurrent detachments. This paper calls into question that dogma, suggesting that completing a vitrectomy via a good peripheral view provided by modern wide-angle viewing systems may be enough to achieve good outcomes rather than trying to remove every last bit of vitreous.