C M Yang1. 1. Ophthalmological Department, National Taiwan University Hospital, Taipei.
Abstract
BACKGROUND AND OBJECTIVE: The presence of extensive choroidal detachment (CD) in eyes with rhegmatogenous retinal detachment (RRD) is a major preoperative complication. Conventional treatment consists of 7 days to a few weeks of systemic and topical steroids followed by scleral buckling and drainage of suprachoroidal fluid. The author studied the usefulness of pars plana vitrectomy in the management of RRD combined with CD. PATIENTS AND METHODS: Ten consecutive patients with RRD complicated by CD were treated with pars plana vitrectomy. Nine had had previous cataract extraction, and one patient had pars plana lensectomy at the time of the surgery. The severity of the CD was evaluated with preoperative ophthalmologic echography. Sclerotomy sites for infusion cannulas were chosen in the area with less CD. Six-millimeter infusion cannulas were used. Pars plana vitrectomy, membrane peeling, and internal fluid-gas exchange with encircling scleral buckle placement were performed in a standard fashion. One patient had silicone oil injected. RESULTS: In each case, suprachoroidal fluid drained spontaneously through the sclerotomy sites around the vitrectomy instruments during the initial course of the operation without extra sclerotomy. Immediate intraoperative retinal reattachment was achieved in 10 cases. The retina remained attached in 9 cases during at least 6 months of follow-up without additional surgery. CONCLUSION: These cases demonstrate the usefulness of pars plana vitrectomy in treating RRD with CD in aphakic or pseudophakic eyes. This method may be an favorable alternative to conventional treatment.
BACKGROUND AND OBJECTIVE: The presence of extensive choroidal detachment (CD) in eyes with rhegmatogenous retinal detachment (RRD) is a major preoperative complication. Conventional treatment consists of 7 days to a few weeks of systemic and topical steroids followed by scleral buckling and drainage of suprachoroidal fluid. The author studied the usefulness of pars plana vitrectomy in the management of RRD combined with CD. PATIENTS AND METHODS: Ten consecutive patients with RRD complicated by CD were treated with pars plana vitrectomy. Nine had had previous cataract extraction, and one patient had pars plana lensectomy at the time of the surgery. The severity of the CD was evaluated with preoperative ophthalmologic echography. Sclerotomy sites for infusion cannulas were chosen in the area with less CD. Six-millimeter infusion cannulas were used. Pars plana vitrectomy, membrane peeling, and internal fluid-gas exchange with encircling scleral buckle placement were performed in a standard fashion. One patient had silicone oil injected. RESULTS: In each case, suprachoroidal fluid drained spontaneously through the sclerotomy sites around the vitrectomy instruments during the initial course of the operation without extra sclerotomy. Immediate intraoperative retinal reattachment was achieved in 10 cases. The retina remained attached in 9 cases during at least 6 months of follow-up without additional surgery. CONCLUSION: These cases demonstrate the usefulness of pars plana vitrectomy in treating RRD with CD in aphakic or pseudophakic eyes. This method may be an favorable alternative to conventional treatment.