Three hundred and sixty degree retinotomy for retinal detachments with severe proliferative vitreoretinopathy.

AIMS: To assess the anatomic and functional results of 360° retinotomy for rhegmatogenous retinal detachment (RD) with severe proliferative vitreoretinopathy (PVR).

MATERIALS AND

METHODS

Retrospective, non-comparative, interventional, case study of 20 consecutive patients. All surgical operations are as follows: vitrectomy, membrane peeling, PFCL, circumferential 360° retinotomy with anterior retinectomy, and silicone oil tamponade. The decision to pursue retinotomy was made during surgery after exploring all conventional techniques and after maximum membrane removal.

RESULTS

The mean number of previous interventions was 1.7 (median 2; range: 0-4). All retinas were reattached at the end of surgery. After 38 months of mean follow-up (range: 18-53 months) the complete retinal reattachment rate was 70 % (14/20). At the end of follow-up, four eyes (20 %) were enucleated and two patients are deceased. Silicone oil was removed in five eyes (25 %). Five eyes (25 %) developed corneal degeneration, four (20 %) rubeosis and one eye (5 %) presented an optic nerve atrophy. Final post-operative visual acuity in eyes with reattached retinas (n = 14) was better or equal to 20/200 in two cases, counting fingers in six cases , hand movements in five cases and light perception in one case.

CONCLUSIONS

Only two of 20 operated eyes (10 %) had visual acuity better or equal to 20/200, but only four eyes (20 %) were enucleated. The aim of 360° retinotomy is to avoid further surgery on already fragile and multi-operated eyes.