Internal drainage of subretinal fluid during scleral buckling with 27-Gauge wide angle viewing system and flute needle for rhegmatogenous retinal detachment.

PURPOSE: To evaluate the clinical therapeutic effects and advantages of internal drainage of subretinal fluid using a 27-gauge wide-angle viewing system(WAVS) and a flute needle compared with external drainage of subretinal fluid (SRF) during scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD).

METHODS: In this prospective randomized case series at two hospitals, we evaluated 43 eyes of 43 patients with RRD who were divided into two groups, A and B. Twenty-two eyes (22 patients) in Group A underwent internal drainage of subretinal fluid with a 27-gauge WAVS and a flute needle, whereas 21 eyes (21 patients) in Group B underwent external drainage of subretinal fluid during scleral buckling surgery. The duration of surgery, rates of retinal reattachment, best corrected visual acuity (BCVA), intraocular pressure (IOPs), occurrence of recurrent RRD, and risk factors of intraoperative or postoperative complications, including subretinal hemorrhage, vitreous hemorrhage, persistent subretinal fluid, postoperative retinal tear, choroidal detachment, vitreous loss, vitreous and retinal incarceration, cystoid macular edema, cataract, glaucoma, and endophthalmitis, of both groups were collected and compared. We followed up these patients for six months after surgery.

RESULTS: The mean operating time of Group A (53.36 ± 6.19 min) was significantly shorter than Group B (61.24 ± 6.84 min) (P = 0.00). The final anatomical success rates were 100%(22/22) and 90.48%(19/21) in Group A and B, respectively (P = 0.14). All detached retinas in Group A reattached before the final follow-up, and no intraoperative or postoperative complications were detected. In Group B, 2(9.52%, 2/21) underwent a second vitrectomy surgery because of subretinal hemorrhage during external drainage of the subretinal fluid. However, the retinas of both eyes reattached at the end of the final follow-up. However, there were two (9.52%, 2/21) other eyes' retinas in Group B that had not completely reattached due to persistent subretinal fluid at the end of this study. The final mean BCVA of Group A (0.21 ± 0.15) was significantly superior to that of Group B(0.39 ± 0.35)(P = 0.04). The intraocular pressure in all the patients was within the normal range throughout the study.

CONCLUSION: Although limited by the small sample size, this study suggests that internal drainage of subretinal fluid during scleral buckling with 27-gauge WAVS and flute needle showed advantages superior to external drainage of subretinal fluid in scleral buckling surgery, including increased efficiency and decreased amount of SRF, shortened duration of persistent subretinal fluid, and reduced rate of subretinal hemorrhage.