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Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study

Eye volume 37, pages 3801–3806 (2023)Cite this article

Subjects

Abstract

Objective

To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy.

Methods

Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months.

Results

Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p = 0.02).

Conclusions

Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.

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Fig. 1: Preoperative fundus picture of 22-year-old patient.
Fig. 2: Two-port dry vitrectomy.
Fig. 3: Postoperative day 1 fundus picture.
Fig. 4: Macular involvement in rhegmatogenous retinal detachment and BCVA changes.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP. One-year outcomes after retinal detachment surgery among Medicare beneficiaries. Am J Ophthalmol. 2010;150:338–45.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Saidkasimova S, Mitry D, Singh J, Yorston D, Charteris DG. Retinal detachment in Scotland is associated with affluence. Br J Ophthalmol. 2009;93:1591–4. https://bjo.bmj.com/content/93/12/1591.

    Article  CAS  PubMed  Google Scholar 

  3. Li JQ, Welchowski T, Schmid M, Holz FG, Finger RP. Incidence of rhegmatogenous retinal detachment in Europe – a systematic review and meta-analysis. Ophthalmologica. 2019;242:81–6.

    Article  PubMed  Google Scholar 

  4. Williamson TH. Chapter 8 – Rhegmatogenous retinal detachment. In: Williamson Thomas H, editor. Vitreoretinal surgery. 2nd ed. Heidelberg: Springer Berlin; 2013. p. 181–230.

  5. Sultan ZN, Agorogiannis EI, Iannetta D, Steel D, Sandinha T. Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management. BMJ Open Ophthalmol. 2020;5:e000474. https://pubmed.ncbi.nlm.nih.gov/33083551.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chronopoulos A, Hattenbach L-O, Schutz JS. Pneumatic retinopexy: a critical reappraisal. Surv Ophthalmol. 2021;66:585–93.

    Article  PubMed  Google Scholar 

  7. Hillier RJ, Felfeli T, Berger AR, Wong DT, Altomare F, Dai D, et al. The pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial (PIVOT). Ophthalmology. 2019;126:531–9. https://doi.org/10.1016/j.ophtha.2018.11.014.

    Article  PubMed  Google Scholar 

  8. Gupta D, Ching J, Tornambe PE. Clinically undetected retinal breaks causing retinal detachment: a review of options for management. Surv Ophthalmol. 2018;63:579–88.

    Article  PubMed  Google Scholar 

  9. Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers R-D, Foerster MH. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology. 2007;114:2142–54.

    Article  PubMed  Google Scholar 

  10. Fallico M, Alosi P, Reibaldi M, Longo A, Bonfiglio V, Avitabile T, et al. Scleral buckling: a review of clinical aspects and current concepts. J Clin Med. 2022;11:314. https://www.mdpi.com/2077-0383/11/2/314.

  11. Gupta B, Neffendorf JE, Williamson TH. Trends and emerging patterns of practice in vitreoretinal surgery. Acta Ophthalmol. 2018;96:e889–90.

    Article  PubMed  Google Scholar 

  12. Ramulu PY, Do DV, Corcoran KJ, Corcoran SL, Robin AL. Use of retinal procedures in Medicare beneficiaries from 1997 to 2007. Arch Ophthalmol. 2010;128:1335–40.

    Article  PubMed  Google Scholar 

  13. Jackson TL, Donachie PHJ, Sparrow JM, Johnston RL. United Kingdom National Ophthalmology Database Study of Vitreoretinal Surgery: report 1; case mix, complications, and cataract. Eye (Lond). 2013;27:644–51.

    Article  CAS  PubMed  Google Scholar 

  14. Holekamp NM, Bai F, Shui Y-B, Almony A, Beebe DC. Ischemic diabetic retinopathy may protect against nuclear sclerotic cataract. Am J Ophthalmol. 2010;150:543–50.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mura M, Engelbrecht L, de Smet MD, Schatz P, Iannetta D, Semidey VA, et al. Minimally interface vitrectomy for rhegmatogenous retinal detachment with a single break in young patients. Am J Ophthalmol Case Rep. 2020;19:100739. https://doi.org/10.1016/j.ajoc.2020.100739.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bonfiglio V, Toro MD, Longo A, Avitabile T, Rejdak R, Nowomiejska K, et al. Modified vitrectomy technique for Phakic rhegmatogenous retinal detachment with intermediate break. J Ophthalmol. 2018;2018:6127932.

  17. Thompson JT, Glaser BM, Sjaarda RN, Murphy RP. Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes. Am J Ophthalmol. 1995;119:48–54.

    Article  CAS  PubMed  Google Scholar 

  18. Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM. An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol. 1991;112:159–65.

    Article  CAS  PubMed  Google Scholar 

  19. Foulds WS. Is your vitreous really necessary? In: Sebag J, editor. Vitreous: in health and disease. New York, NY: Springer; 2014.

  20. Shui Y-B, Holekamp NM, Kramer BC, Crowley JR, Wilkins MA, Chu F, et al. The gel state of the vitreous and ascorbate-dependent oxygen consumption: relationship to the etiology of nuclear cataracts. Arch Ophthalmol. 2009;127:475–82.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sheibani N, Sorenson CM, Cornelius LA, Frazier WA. Thrombospondin-1, a natural inhibitor of angiogenesis, is present in vitreous and aqueous humor and is modulated by hyperglycemia. Biochem Biophys Res Commun. 2000;267:257–61.

    Article  CAS  PubMed  Google Scholar 

  22. Holekamp NM, Shui Y-B, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation. Am J Ophthalmol. 2005;139:302–10.

    Article  PubMed  Google Scholar 

  23. Chang S. LXII Edward Jackson lecture: open angle glaucoma after vitrectomy. Am J Ophthalmol. 2006;141:1033–43.

    Article  PubMed  Google Scholar 

  24. Yang I-H, Lee J-J, Wu P-C, Kuo H-K, Kuo Y-H, Huang H-M. Oxidative stress enhanced the transforming growth factor-β2-induced epithelial-mesenchymal transition through chemokine ligand 1 on ARPE-19 cell. Sci Rep. 2020;10:4000. https://doi.org/10.1038/s41598-020-60785-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Tornambe PE, Hilton GF. Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group. Ophthalmology. 1989;96:772–83. Discussion 784.

    Article  CAS  PubMed  Google Scholar 

  26. Chan CK, Lin SG, Nuthi ASD, Salib DM. Pneumatic retinopexy for the repair of retinal detachments: a comprehensive review (1986-2007). Surv Ophthalmol. 2008;53:443–78.

    Article  PubMed  Google Scholar 

  27. Jalil A, Ho WO, Charles S, Dhawahir-Scala F, Patton N. Iatrogenic retinal breaks in 20-G versus 23-G pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2013;251:1463–7. https://doi.org/10.1007/s00417-013-2299-2.

    Article  PubMed  Google Scholar 

  28. Elhousseini Z, Lee E, Williamson TH. Incidence of lens touch during pars plana vitrectomy and outcomes from subsequent cataract surgery. Retina. 2016;36:825–9. https://journals.lww.com/retinajournal/Fulltext/2016/04000/INCIDENCE_OF_LENS_TOUCH_DURING_PARS_PLANA.24.aspx.

  29. Merad M, Vérité F, Baudin F, Ghezala IB, Meillon C, Bron AM, et al. Cystoid macular edema after rhegmatogenous retinal detachment repair with pars plana vitrectomy: rate, risk factors, and outcomes. J Clin Med. 2022;11:4914.

  30. van den Biesen PR, Berenschot T, Verdaasdonk RM, van Weelden H, van Norren D. Endoillumination during vitrectomy and phototoxicity thresholds. Br J Ophthalmol. 2000;84:1372–5.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gharbiya M, Visioli G, Iannetti L, Iannaccone A, Tamburrelli AC, Marenco M, et al. Comparison between scleral buckling and vitrectomy in the onset of cystoid macular edema and epiretinal membrane after rhegmatogenous retinal detachment repair. Retina. 2022;42:1268–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Author notes

  1. These authors contributed equally: Enrico Peiretti, Tomaso Caporossi.

Authors and Affiliations

  1. Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

    Enrico Peiretti, Filippo Tatti, Lorenzo Mangoni, Emanuele Siotto Pintor & Valentina Carta

  2. Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy

    Tomaso Caporossi & Alessandra Scampoli

  3. Catholic University Sacro Cuore, Rome, Italy

    Tomaso Caporossi, Alessandra Scampoli, Matteo Mario Carlà & Stanislao Rizzo

  4. Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Matteo Mario Carlà & Stanislao Rizzo

  5. Multidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli, Naples, Italy

    Claudio Iovino

Authors
  1. Enrico Peiretti
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Contributions

Study concept and design: EP, TC. Acquisition, analysis, and interpretation of data: LM, MMC, ESP, VC. Drafting of the manuscript: EP, TC, FT, AS. Critical revision of the manuscript: CI and SR. Statistical analysis: FT, AS. Administrative, technical, or material support: ESP, LM. Supervision: EP, TC, SR.

Corresponding author

Correspondence to Enrico Peiretti.

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Peiretti, E., Caporossi, T., Tatti, F. et al. Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study. Eye 37, 3801–3806 (2023). https://doi.org/10.1038/s41433-023-02617-6

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