Singh RSJ, Covert DJ, Henry CR, Bhatia SK, Croskrey J, Sanchez CR, Han DP. Retinal Complications Associated With Pars Plana Vitrectomy for Macular Holes or Epiretinal Membranes in Eyes With Previous Retinal Detachment Repair. JAMA Ophthalmol. 2014;132(1):118-119. doi:10.1001/jamaophthalmol.2013.5698
Pars plana vitrectomy (PPV) is associated with risk of intraoperative retinal tears (RTs) and postoperative rhegmatogenous retinal detachment (RRD). Eyes undergoing RRD repair are at higher risk for developing subsequent epiretinal membranes (ERMs) that may compromise vision.1,2 For cannulated surgery as compared with standard 20-gauge PPV, we previously reported markedly lower of risk of intraoperative RT (3.3% vs 23.0%, respectively) and a trend toward reduced risk of postoperative RD (2.8% vs 5.9%, respectively).3 However, in eyes with previous RRD repair, risks of these events are not well documented. Therefore, we evaluated eyes with previous RRD repair undergoing PPV for ERMs or macular holes (MHs) and compared them with eyes without prior RRD.
A retrospective review was performed on a consecutive series of eyes undergoing PPV for MH or ERM from January 1, 2003, through December 31, 2009.3 From these, cases that had undergone prior RRD repair were selected for this study. The variables studied included patient demographic characteristics, interventions at prior RRD repair, and microsurgical approach. The study was approved by the institutional review board of the Medical College of Wisconsin. The requirement for written informed consent was waived by the institutional review board.
A total of 466 eyes underwent PPV for MH or ERM, of which 40 eyes (10 with MH and 30 with ERM) had a history of RRD repair and were selected for analysis. Mean follow-up was 77 weeks (range, 10-254 weeks). Thirty-nine of the 40 eyes had their prior RD repaired with PPV, 29 of these with a scleral buckle (SB); only 1 had previous SB alone. The overall rate of intraoperative RT was 2.5% (1 of 40 eyes). It occurred in 1 of 23 eyes (4.3%) during noncannulated PPV and none of 17 eyes during cannulated surgery. This eye had a prior SB in place and did not develop recurrent RD postoperatively. The overall rate of postoperative recurrent RRD was 7.5% (3 of 40 eyes) and was not influenced by the choice of standard 20-gauge PPV (1 of 23 eyes [4.3%]) or cannulated surgery (2 of 17 eyes [11.7%]) (P = .56, Fisher exact test). Recurrent RRD developed in 1 of 29 eyes (3.4%) that had a prior SB with PPV compared with 2 of 10 eyes (20.0%) that had their prior RRD repaired with PPV without an SB (P = .16, Fisher exact test). In 2 eyes without a previous SB, recurrent RRDs developed 4 and 5 weeks in the postoperative period, caused by new RTs within 1 clock hour of a previous sclerotomy. The third case had RRD 51 weeks later. The indication for PPV (MH or ERM) or lens status (phakic, aphakic, or pseudophakic) did not influence the rate of intraoperative RT or recurrent RRD (Table). The rates of intraoperative RT and recurrent RRD in eyes with previous RRD repair in this study were not significantly different from those for eyes without prior RRD3 (12.7% [54 of 426 eyes; P = .07] and 4.9% [21 of 426 eyes; P = .48], respectively).
Eyes with prior RRD repair that undergo PPV for ERM or MH do not appear to be at significantly different risk for postvitrectomy RRD compared with eyes without a history of RRD that undergo such surgery. We observed a somewhat reduced rate of intraoperative RT in eyes with previous RD repair (P = .07) and a lower risk of recurrent RD if previous SB had been performed (P = .16), although the differences did not reach statistical significance. Our study is limited by its retrospective design and small number of patients in subgroups. Council et al4 reported a recurrent RD rate of 6.7%, which is comparable to our observed rate of 7.5%. In distinction, our study cohort was derived from a larger pool3 that provided a reference group without previous RD.
Corresponding Author: Dennis P. Han, MD, Department of Ophthalmology, Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI 53226 (firstname.lastname@example.org).
Published Online: November 21, 2013. doi:10.1001/jamaophthalmol.2013.5698.
Author Contributions: Drs Singh and Han had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Singh, Covert, Henry, Bhatia, Han.
Acquisition of data: Covert, Henry, Bhatia, Croskrey, Sanchez, Han.
Analysis and interpretation of data: Singh, Henry, Bhatia, Han.
Drafting of the manuscript: Singh, Han.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Singh, Covert, Henry, Bhatia, Croskrey.
Study supervision: Han.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc (Medical College of Wisconsin), by the Thomas M. Aaberg Sr Retina Research Fund, and by the Jack A. and Elaine D. Klieger Professorship in Ophthalmology (Dr Han).
Role of the Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.