Concept and application of relaxing radial retinectomy for retinal detachment with advanced proliferative vitreo-retinopathy

Abstract

Purpose: To revisit the concept of retinectomy and the theory of mechanical forces on the retina occurring in rhegmatogenous retinal detachment (RRD) and to describe the potential application of radial retinectomy in RRD with advanced proliferative vitreoretinopathy (PVR).

Methods: A literature search was performed to identify all English language articles reporting the use of retinectomy for the management of RRD with PVR. We reviewed the theoretical background of mechanical forces occurring in RRD.

Results: Detachment of the retina from the retinal pigment epithelium (RPE)/choroid is influenced by disequilibrium of several physical forces: tangential forces on the epiretinal membrane $\left(T_1\right)$ and radial traction on the retina $F_R$ exceeding the retinal adhesion force to the RPE $\left(T_1\text{+}{F}_R\text{>}{F}_A\right)$ . PVR may exaggerate the amounts of tangential and radial forces ( $\left(T_1\right)$ and $F_R$ ) that pull the retina off. Relaxing radial retinectomy, by the nature of its cutting pattern, may theoretically decrease the amounts of both forces, therefore restoring the equilibrium between tensile and adhesive forces on the retinal surface $\left(T_1\text{+}{F}_R\text{=}{F}_A\right)$ .

Conclusion: Relaxing radial retinectomy may potentially be applied in RRD with advanced PVR but has rarely been reported to date. Future studies are needed to evaluate its outcomes and long-term complications.

Keywords: Proliferative vitreoretinopathy; Radial retinectomy; Relaxing retinectomy; Rhegmatogenous retinal detachment; Vitrectomy.