Vitrectomy with retinectomy for rhegmatogenous retinal detachment (RRD) can achieve high rates of success even without removing the lens.
This retrospective cohort study used Current Procedural Terminology code 67113 to identify patients who underwent repair of complex retinal detachment with vitrectomy and membrane peeling. Inclusion criteria consisted of patients with phakic eyes who had primary or secondary lens-sparing RRD repair with relaxing retinectomy for proliferative vitreoretinopathy (PVR) and a minimum of 6 months of follow-up to assess for single-surgery anatomic success (SASS).
Of the 112 patients in the study group, 75% percent achieved SASS following lens-sparing vitrectomy with retinectomy at 3 months; 65% were successful at 6 months. All but 1 patient achieved complete retinal reattachment in a mean of 29 months. At the time of initial surgery, only 13% of patients presented with PVR; 87% of patients developed PVR after previous RRD repair. Of these, 61% had primary pars plana vitrectomy (PPV), 31% had PPV + scleral buckling (SB), and 8% had primary SB failure. Three months after initial lens-sparing retinectomy surgery, there was no correlation between SASS and tamponade choice (oil vs C3F8), vitreous shave, macula status, size of retinectomy, or location of retinectomy. Predictors of final visual acuity included vision prior to retinectomy, silicone oil presence, and lens status at the last exam.
Some doctors believe retinectomy size may influence final visual acuity, but this study noted no significant association between these two factors. As a retrospective cohort study, this investigation lacks a control group. Additionally, the follow-up period was relatively long with specific data points at 3 and 6 months, which may not align with timepoints used in other studies and could make results difficult to compare.
This study shows that lens-sparing vitrectomy with retinectomy can achieve a high rate of SASS and that performing a lensectomy with anterior vitreous base dissection for all of these cases may not be necessary. Early intervention is also recommended, as pre-retinectomy visual acuity was a significant predictor of final visual acuity.
Financial Disclosures: Dr. Jessica Randolph discloses financial relationships with Astellas and Genentech (Consultant/Advisor).