Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng P...Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.展开更多
文摘Background: Rhegmatogenous retinal detachments (RRD) with inferior breaks are usually treated by scleral buckling (SB) or pars plan a vitrectomy (PPV) or a combination of both methods. However, applying a SB duri ng PPV may produce a risk of choroidal haemorrhage. Following a recent pilot stu dy showing that such cases can be safely treated by PPV without SB the authors r e examined their management of RRD in which inferior breaks were present. Metho ds: All patients had a detached vitreous and a complex configuration of retinal breaks. A case control study was performed to analyse the surgical methods and results of PPV on 48 consecutive patients with RRD associated with inferior brea ks and 48 age/sex matched controls who underwent PPV for RRD without inferior br eaks. Exclusion criteria were giant retinal tears, retinal dialysis, trauma, pro liferative vitreoretinopathy (PVR) grade B or higher, schisis detachments, and e yes that had been operated previously for RRD. A simple algorithm was followed t o manage patients with inferior breaks. All patients underwent a standard three port PPV with intraocular gas tamponade without supplementary SB. Patients were asked to posture face up or right or left side down for 1 week. Results: 39 of t he 48 patients (81.3%) with inferior breaks were treated successfully with one operation. 41 of 48 patients (85.4%) control patients achieved primary success. The final success rate was 95.8%in both groups. There was no statistical diffe rence between the two groups. When all the cases of RRD were analysed (including external plomb/non drain procedures) the primary success rate was 89%and fina l success rate 97.5%Conclusions: This study has shown that acceptable success r ates can be achieved using PPV alone to treat RRD with inferior breaks. Complica tions are minimised and patients in this high risk group have an 81%chance of p rimary success. Pars plana vitrectomy and gas will successfully reattach the ret ina and a supplementary SB, to support the inferior retina, is unnecessary as th e intraocular gas, and face up or, right or left side down positioning will tamp onade breaks satisfactorily.
