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Endoscopy assisted vitrectomy (eav) and internal tamponade for aphakic/pseudophakic retinal detachment , preliminary results .

Claude Boscher

Paris, France

Purpose :. Eav allows tangential approach and high magnification viewing and removal on 360° of the anterior " zonular " and posterior parts of the vitreous base whatever the conditions of transparency of the anterior segment. The purpose of the study is to report 1) the results of eav for aphakic/pseudophakic retinal detachment as a primary and single procedure (without buckle surgery) 2) the results of eav for aphakic/pseudophakic retinal detachment after failure of previous other procedure(s).

Methods : prospective , non randomized , non comparative, consecutive interventional case series . Exclusion criteria : retinal detachment in aphakic/pseudophakic eyes secondary to : trauma , proliferative retinopathy , retinoschisis , high myopia with posterior staphyloma. From September 1999 to February 2002 , 37 eyes ( 35 pseudophakic , 2 aphakic with permanent keratoprosthesis) , of 36 patients (10 females , 26 males , aged from 43 to 84 years (mean 64 ) , 3 monocular ) ha ve been included,. Eav was performed as a primary and single procedure in 26/37 eyes (70%)( including 5/26 (19%) with anterior PVR) , after failure of previous surgery(ies) in 11/37 eyes (30%) ( buckle surgery : 6 eyes , conventional vitrectomy : 3 eyes , both : 1 eye ) . 16/37 eyes (43%) presented with anterior PVR at preoperative clinical examination , 3/37 eyes (8%) with posterior PVR only (D1) . A fiber optics endoscopic system including a laser channel , and a peristaltic pump vitrectomy maehine were used to perform 360° hyaloido capsulozonular dissection , to peel the anterior and posterior parts of the vitreous base , and to clean the sclerotomies . Perioperative retinopexy ( cryotherapy and/or endolaser ) were applied exclusively around retinal tears / holes in eyes without PVR , perioperative and post operative additional retinopexy have been performed in eyes with PVR . Internal tamponade was performed with gas in 24 eyes , silicone oil in 13 eyes .

Results : additional information compared to preoperative examination (tear(s), additional tear(s) ,mecanism of RD , endoscopic risk factors for anterior PVR, ciliary detachment ) has been provided by endoscopic viewing in 15 eyes (41%). Overall final anatomical success is 37/37 eyes (100%) ; silicone oil is still present in 7/13 eyes ( 6 eyes with anterior PVR , 1 eye with posterior PVR) . Initial success rate of eav as a primary and single procedure is 25/26 (96%). Initial success rate of eav after failure of previous surgery(ies) is 8/11 eyes (73%).; 4/37 (11%) eyes redetached and were successfully reattached in one subsequent procedure Visual acuity in eyes with eav as a primary and single procedure is ³ 20/40 in 13/26 (50 %) eyes . Visual acuity in eyes with eav after failure of previous surgeri(es) is ³ 20/200 in 6/11 eyes ( 55 %) .

Conclusion : 96% initial eav success rate with 50% visual acuity 20/40 , as a primary and single procedure without buckle, in a series including 19% ratio of anterior PVR cases , is good , and there are no specific complications related to the technique. However samples are too small to draw definite conclusions from the subgroups , anterior PVR , failures of previous surgeries , and to compare with other techniques .