Tailored vitrectomy and laser photocoagulation without scleral buckling for all primary rhegmatogenous retinal detachments

Aim: To investigate the anatomical and functional results and the complications in eyes operated on using vitrectomy without scleral buckling for all forms of rhegmatogenous retinal detachment ( RRD). Methods: All cases of primary RRD at the University Hospital of Lund, Lund, Sweden, treated by one surgeon during a period of 3 years were retrospectively reviewed. In 131 ( 98%) of 134 consecutive cases, a final follow-up record of 3 - 14 months was obtained, and these eyes were included in the study. The surgical protocol was tailored for each case and consisted of vitrectomy, laser photocoagulation and tamponade. Preoperative and intraoperative variables were analyses for risk for redetachment and postoperative proliferative vitreoretinopathy ( PVR). Results: Complete reattachment was achieved in 87% of cases ( 114/131) after one operation and in 95% cases after >= 1 operation. A primary detachment of > 1 quadrant was the only significant risk factor for redetachment ( p < 0.05). The most common cause of redetachment was progressive PVR. Significant risk and factors for PVR postoperatively were a poor preoperative visual acuity and a high number of laser effects during surgery ( p < 0.05). The visual acuity for the total number of eyes, macula-off eyes, and pseudophakic as well as phakic eyes, improved significantly. The visual acuity for macula-on eyes did not change significantly. Six patients developed ocular hypertension and another 6 an epiretinal membrane. Three patients reported a visual field defect. Increased lens opacification was seen in 64 of the 94 ( 68%) phakic eyes. Conclusions: The tailored vitrectomy protocol is well suited to all types of RRD. Increased lens opacification in phakic eyes is common, but visual acuity is considerably improved in phakic as well as pseudophakic eyes. PVR development postoperatively is related to the extent of laser treatment, indicating that the protocol may be even further optimised in the future.