Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy

Aniruddha Agarwal; Nitin Kumar Menia; Ashish Markan; Ahmed B Sallam; Ahmed Habib; Ahmed Mansour; Claudio Iovino; Enrico Peiretti; Sibel Demirel; Mohamed Ahmed Tawfiq; Mostafa Hanout; Vishali Gupta; Nicola Ghazi; Sabyasachi Sengupta

doi:10.4103/IJO.IJO_2840_23

Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy

Indian J Ophthalmol. 2024 Apr 16. doi: 10.4103/IJO.IJO_2840_23. Online ahead of print.

Authors

Aniruddha Agarwal^{1

2

3}, Nitin Kumar Menia⁴, Ashish Markan⁵, Ahmed B Sallam⁶, Ahmed Habib⁷, Ahmed Mansour⁷, Claudio Iovino⁸, Enrico Peiretti⁹, Sibel Demirel¹⁰, Mohamed Ahmed Tawfiq¹¹, Mostafa Hanout¹², Vishali Gupta¹³, Nicola Ghazi^{1

2}, Sabyasachi Sengupta¹⁴

Affiliations

¹ The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE).
² Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
³ Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands.
⁴ Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jammu, India.
⁵ Department of Ophthalmology, Eye7 Chaudhary Eye Center, New Delhi, India.
⁶ Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁷ Department of Ophthalmology, Ain Shams University, Vitreoretinal Service, Al Mashreq Eye Hospital, Cairo, Egypt.
⁸ Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
⁹ Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
¹⁰ Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
¹¹ Department of Ophthalmology, Al Ferdaws Eye Hospital, Zagazig, Egypt.
¹² Princess Margaret Cancer Center/University Health Network, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
¹³ Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
¹⁴ Future Vision Eye Care, Mumbai, Maharashtra, India.

PMID: 38622862
DOI: 10.4103/IJO.IJO_2840_23

Abstract

Purpose: To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV).

Methods: In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications.

Results: Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD.

Conclusion: After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.