• Outcomes of RRD Repair

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD

    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    Published online July 3, 2021

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    Vounotrypidis et al. reviewed final outcomes for nonvitrectomized eyes that developed rhegmatogenous retinal detachment (RRD) following intravitreal injections. They found that anatomic results generally were acceptable after one surgical interven­tion, but visual outcomes were poor for most patients. In addition, they found that, when compared with anti-VEGF agents, the dexamethasone implant and ocriplasmin injections were linked to higher rates of incident RRD, recurrent RRD, and proliferative vitreoretinopa­thy (PVR).

    For this retrospective review, the authors included all nonvitrectomized phakic and pseudophakic eyes of patients from two vitreoretinal centers in Europe. Eyes that developed RRD after intravitreal therapy were treated promptly with either 1) scleral buckling with cryopexy, 2) standard small-gauge pars plana vitrectomy (PPV) with laser retinopexy, or 3) a combination of these procedures. All cases of recurrent RRD underwent PPV. Main outcomes were the rates of primary and second­ary retinal attachment after surgery, the rate of PVR, and functional results. In one center, 10-year RRD incidence rates per injection were calculated.

    Fifty-two eyes (52 patients) met the inclusion criteria. The success rates for primary and secondary anatomic repair were 83% (n = 43) and 96% (n = 50), respectively. PVR was noted in three eyes with uveitis, in two eyes with postoperative cystoid macular edema, and in eight of nine eyes that received a dexamethasone implant. The presence of PVR was unrelated to age, number of injections, duration of symptoms, or time from the last injection to the de­tachment. Mean best-corrected visual acuity improved in 28 eyes, remained stable in 16, and worsened in eight.

    With regard to specific intravit­real medications, the 10-year RRD rates were 0.04% for ranibizumab, 0.109% for bevacizumab, and 0.214% for dexamethasone. Aflibercept and ocriplasmin were in use for seven of the 10 years and had RRD rates of 0.007 and 1.527%, respectively, during that time. The higher rate of detachment with dexamethasone may reflect the relatively large sclerotomy, wide needle, and/or underlying disease, said the authors, who recommend exploring the potential role of these factors in the development of PVR.

    The original article can be found here.