Program list

SYMPOSIUM: STRATEGIES
SECTION: To prevent complicated stages of PVR
Moderators: William Mieler, Francesco Boscia
Tuesday, September 16th, 2003 ; 8:30 - 9:50

ENDOSCOPY ASSISTED VITRECTOMY WITHOUT BUCKLE FOR PREVENTION OF PVR
Claude Boscher
Paris, France

Purpose: to evaluate endoscopic 360° high magnification evaluation of Anterior Vitreous Base (AVB), peeling of the anterior vitreous cortex as a scaffold for cell growth , and removal of pigmented and white clumps deposited from the ciliary margin to the vitreoretinal juncture, with internal tamponade, and without buckle , in the prevention of PVR in eyes at risk.
Methods: consecutive prospective study of 48 eyes (20 phakic, 27 pseudophakic,1aphakic), enrolled between september 1999 and december 2002, presenting rhegmatogenous Retinal Detachment, with PVR grade A or B at preoperative examination, and at least 2 of the 7 endoscopic intraoperative AVB criteria associated to PVR we reported recently (" en bloc " stiff anterior vitreous retraction, granulations inside the anterior part of AVB, ciliary detachment, anterior ciliary/retinal displacement, " wrinkling " of posterior attachment of the VB, tractional anterior retinal surface hemorrhages, uncomplete retinal flattening under PerFluoroCarbonLiquids ). 8% eyes had a history of trauma , 17% eyes presented a giant tear; 12% eyes were operated after failure of conventional surgery. Gas tamponade was used in 64% eyes, silicone oil in 36%, without (additional) buckling ;silicone oil has been removed in all but 2 eyes. Follow up ranges from 4 to 42 months (mean 19).
Results : retinal redetachment occured in 7/48 (14.5%): after gas resorption in 4 eyes and under oil in 3 eyes . Redetachment was due to PVR in 2/48 (4%) eyes , to ILM retraction in 2 eyes , to insufficient pexy in 3 eyes .5/7 eyes with recurrence were fixed with one reoperation. Final reattachment rate is 96%(46/48 eyes). Cataract developed in 70% of phakic eyes and was due to intraoperative lens injury in 3 patients under 40 years of age.
Conclusion : in eyes at risk for development of PVR : EAV might reduce the rate of failure of conventional vitrectomy and suppress the need for scleral buckle.