CLINICAL CHARACTERISTICS AND EARLY OUTCOMES OFPARS PLANA VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT AT HIGH RISK FOR PROLIFERATIVE VITREORETINOPATHY
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Abstract
Objective: To describe the clinical characteristics and risk features associated with proliferative vitreoretinopathy (PVR), and to evaluate the early outcomes of pars plana vitrectomy for primary rhegmatogenous retinal detachment in eyes at high risk for PVR at Hanoi Eye Hospital.
Subjects and Methods: This prospective, uncontrolled interventional study included 79 eyes of 79 patients with primary rhegmatogenous retinal detachment and at least one high-risk feature for PVR who underwent pars plana vitrectomy at Hanoi Eye Hospital between February 2024 and December 2024. Recorded high-risk features included extensive retinal detachment involving two or more quadrants, large retinal tears exceeding three disc diameters, vitreous hemorrhage, choroidal detachment, and uveitis; the presence of preoperative PVR was also documented. Preoperative clinical characteristics, surgical procedures, retinal attachment status, best-corrected visual acuity, and postoperative complications were evaluated.
Results: The mean patient age was 55.1 ± 17.1 years, and 62.0% were male. A total of 51.9% of patients presented more than 30 days after symptom onset, and 94.9% of eyes had macula-off retinal detachment. Extensive retinal detachment was the most common high-risk feature (87.3%), followed by large retinal tears (46.8%), vitreous hemorrhage (16.5%), preoperative PVR (16.5%), uveitis (8.9%), and choroidal detachment (1.3%). Overall, 54.4% of eyes had two or more high-risk features. Retinal attachment rates were 98.7% on postoperative day 1, 93.4% at 1 week, 88.0% at 1 month, and 86.8% at the final anatomical assessment according to the study criteria. Mean best-corrected visual acuity improved from 2.10 ± 0.85 logMAR preoperatively to 0.96 ± 0.65 logMAR at 3 months (p<0.001).
Conclusion: Patients with primary rhegmatogenous retinal detachment at high risk for PVR treated at Hanoi Eye Hospital commonly presented with advanced disease, characterized by high rates of macula-off and extensive retinal detachment. Extensive retinal detachment and large retinal tears were the two most frequent high-risk features. Pars plana vitrectomy provided favorable early anatomical and functional outcomes; however, postoperative PVR remained an important concern in this high-risk population.
Keywords
Rhegmatogenous retinal detachment, proliferative vitreoretinopathy, pars plana vitrectomy, silicone oil, surgical outcomes
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References
2. J X, J F, J W. Risk factors for proliferative vitreoretinopathy after retinal detachment surgery: A systematic review and meta-analysis. PloS one. 2023;18(10).
3. Kurochkin P, Huang N, Petrela R, Rosenberg KI, Brown JS, Oellers P. Pars Plana Vitrectomy Outcomes for Rhegmatogenous Retinal Detachment Qualifying for Pneumatic Retinopexy. Clin Ophthalmol. 2021;15:1207-1214.
4. Elghawy O, Duong R, Nigussie A, Bogaard JD, Patrie J, Shildkrot Y. Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study. BMC Ophthalmol. 2022;22(1):136.
5. Hébert M, You E, Garneau J, et al. Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle. retina. 2022;42(6):1161-1169.
6. Ohara H, Yuasa Y, Harada Y, et al. Drainage retinotomy is a risk factor for surgical failure after pars plana vitrectomy in patients with primary uncomplicated rhegmatogenous retinal detachment. Retina. 2022;42(12):2307-2314.