Outcomes and Complications of Rhegmatogenous Retinal Detachment Repair with Selective Suture less 25-Gauge Pars Plana Vitrectomy

PURPOSE: To evaluate the outcomes and complications associated with the repair of rhegmatogenous retinal detachment (RRD) using 25-gauge pars plana vitrectomy (PPV) with selective sclerotomy suturing. DESIGN: Retrospective case series. METHODS: Analysis of consecutive 25-gauge pars plana vitrectomy cases performed for treating RRD was conducted. Reviewed parameters included demographics, ophthalmic history, results of ocular examinations, and intraoperative as well as postoperative complications. Analysis of the surgery digital video disc recordings revealed complications such as iatrogenic retinal breaks and retinal or subretinal tugging by the soft-tip cannula. RESULTS: Forty-two eyes with RRD were evaluated with a follow-up of at least 3 months. The preoperative best-corrected visual acuity (BCVA) of 20 eyes with macula-on RRD ranged between 20/20 and 20/40 (mean, 20/30). Twenty-two eyes with macula-off RRD had preoperative BCVA ranging between 20/70 and hand movements (mean, 20/400). The single-surgery success rate was 97.4%. The final BCVA of the macula-on eyes ranged between 20/20 and 20/40 (mean, 20/30). In the eyes with macula-off RRD, the postoperative BCVA ranged between 20/30 and 20/400 (mean, 20/73). Sutures were placed on at least 1 scleral wound because of intraoperative gas leakage in 36.4% of the eyes. On the first postoperative day, all the eyes receiving gas tamponade had a 100% fill. None of the eyes in the study had postoperative hypotony, ciliochoroidal effusion, or choroidal hemorrhage. No cases of postoperative subconjunctival gas or oil leakage were noted. CONCLUSIONS: Modification of the standard 25-gauge sutureless technique with selective scleral wound suturing may contribute to preventing wound leakage and possible postoperative complications of hypotony or partial tamponade. (Am J Ophthalmol 2010;149:630-634. (C) 2010 by Elsevier Inc. All rights reserved.)