[Outcome after vitrectomy in rhegmatogenous retinal detachment and dense vitreous opacities].

BACKGROUND: In some cases of rhegmatogenous retinal detachment dense vitreous opacities can delay the diagnosis and prevent a scleral buckling procedure. In these cases a primary vitrectomy is necessary. These results of vitrectomy are of current interest, because intra- and postoperative complications are comparable to the group of patients with retinal detachment and clear media, in which primary vitrectomy is discussed today as an alternative method.

PATIENTS AND METHODS: After redetachment and trauma were excluded, we reviewed the charts of 40 patients (40 eyes), who underwent vitrectomy and gas endotamponade for rhegmatogenous retinal detachment and dense vitreous opacities. In 31 cases vitreous hemorrhage and in 9 cases other dense non inflammatory vitreous opacities were present. Intraoperatively detected PVR (1), giant tear (1) and retinal holes located at the posterior pole (1) were excluded. The remaining 37 eyes were examined retrospectively. The median follow-up time was 12 months.

RESULTS: In 32 of 37 eyes the retina was reattached after the first vitrectomy (86.5%). In 5 eyes a redetachment occurred, in 3 of them caused by PVR. After revitrectomy successful reattachment could be achieved in all cases. As intraoperative complications iatrogenic retinal break formation could be observed in 3 cases and lens-touch in 1 case. Postoperatively secondary tears in attached retina developed in 2 cases, in 1 case an arterial branch occlusion and in 1 case a Macular-Pucker. During the follow-up period a cataract developed in 12 of the 21 phacic patients.

CONCLUSIONS: The reattachment rate of primary vitrectomy in eyes with retinal detachment and associated dense vitreous opacities is slightly lower compared to the rate of scleral buckling procedures in cases of retinal detachment with clear media. Comparable good or even better results may be expected for primary vitrectomy in cases of retinal detachment without vitreous opacities. Since the risk of intra- and postoperative complications in our group of patients is small it is promising also for primary vitrectomy in cases with good view on the fundus.