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  • Comparison of 3 drainage techniques in patients undergoing vitrectomy for RRD

    Retina/Vitreous

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    Review of: Evaluation of subretinal fluid drainage techniques during PPV for primary RRD—ELLIPSOID STUDY

    Pflugfelder S, Massaro-Giordano M, Perez V, et al. Ophthalmology, January 2021


    Visual outcomes and photoreceptor integrity were compared among 3 drainage techniques used in patients undergoing vitrectomy for rhegmatogenous retinal detachment: perfluorocarbon liquid (PFCL), drainage from peripheral break (PRB), and peripheral retinotomy (PR) with the result that PFCL may lead to inferior outcomes.

    Study design

    This retrospective, single-center, multisurgeon trial compared 300 eyes undergoing vitrectomy (PPV) for primary macula-off rhegmatogenous retinal detachment (RRD) using three different drainage techniques, perfluorocarbon liquid (PFCL), drainage from peripheral break (PRB), and peripheral retinotomy (PR). Visual outcomes and photoreceptor integrity were compared among the three groups.

    Outcomes

    All three drainage techniques are associated with similar single-operation anatomic reattachment rates. That said, OCT image analysis demonstrates that PFCL is associated with a greater risk of discontinuity of the foveal external limiting membrane (PRB 26%, PR 24%, PFCL 44%, P = 0.001), ellipsoid zone (PRB 29%, PR 31%, PFCL 49%, P < 0.001), and the interdigitation zone (PRB 43%, PR 39%, PRFC 56%, P = 0.004), with associated decreased visual acuity at 12 months. The risk of epiretinal membrane formation was significantly higher in the PR group as compared to the PRB and PFCL groups (PRB 64%, PR 90%, PFCL 61%, P < 0.001). An association between drainage techniques and cystoid macular edema was also found (PRB 28%, PR 39%, PFCL 46%, P = 0.003).

    Limitations

    The major limitation of this study was its retrospective design. Drainage technique was at the preference of the surgeon, but it is possible that subtle intraoperative findings may have influenced the decision to choose a particular drainage technique.

    Clinical significance

    Prior teaching often dictated that drainage from a peripheral tear should be avoided in macula-off detachments for fear of the development of retinal folds in the macula. This article demonstrates that excellent visual outcomes can be obtained with this technique. The high rate of ERM reported here with PR should be looked at more closely as whether these membranes were visually significant was not discussed. Finally, PFCL should be used with caution. It is not only costly but may lead to inferior visual outcomes.