Abstract

SO.07.03

Management of primary rhegmatogenous retinal detachment complicated by PVR

Imshenetskaya T., Vashcevich G., Isotova O.
Department of Ophtalmology, Belarus Postgraduate Academy of Medicine, Minsk, Belarus

Objective: Proliferative vitreoretinopathy (PVR) is the main cause of failures in surgical treatment of rhegmatogenous retinal detachment. For this reason, we try to find the optimal surgical approach for treating retinal detachment complicated by PVR.
Methods: From January 2006 through January 2006, we observed 171 patients with rhegmatogenous retinal detachment, complicated by PVR. In our investigation we preferred to combine, B – scanning, optical coherence tomography (OCT), distant infra-red thermography, All the patients had the encircling band treatment which not only facilitated to have the retina reattached but also permitted to resect the opaque vitreous at its base more thoroughly during pars plana vtrectomy. This prevented futher progression of anterior PVR.
Results: We succeeded in stabililising PVR in 103 cases (A and B grade) by merely using encircling band and scleral buckling without application of subretinal fluid drainage and cryotherapy. In case of indications, we additionally performed argon laser photocoagulation at the early and post surgical periods for creation more sever retinal adhesion. Besides extrascleral intervention, 68 patients had pars plana vitrectomy, using perfluorodecalin with diode laser endophotocoagulation, at the end of retinopexy, perfluorodecalin was removed and changed by sulfur hexafluoride (SF6) in 57 cases and by silicone oil in 11 cases. To stabilize PVR, 111 patients had to have one surgical procedure, 43 patients were operated on twice because of recurrent PVR, in 17 cases 3 operations proved necessary. As a result of the treatment, 149 patients had visual acuity improvment (87,1%) and 12 patients had only an anatomical success.
Conclusions: The results of the surgical treatment of rhegmatogenous retinal detachment depends on the stage of PVR. Scleral buckling procedures are the treatment of choice for the maiority of retinal detachment, complicated by PVR (stage A and B). OCT revealed postoperative residual subretinal fluid at the macula for at least 6 months after surgery.

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