Strategy for the Management of Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy

Abstract

Purpose: To device a strategy for the proper surgical management of rhegmatogenous retinal detachment with proliferative vitreoretinno-pathy.

Material and Methods: This prospective study was carried out in the ophthalmology department of Sir Ganga Ram hospital. In this study, twenty-five cases were selected. The cases were divided into three groups according to the surgical techniques. In the first group, scleral buckling was done. In the second group, pars plana vitrectomy was done and silicone oil was used for internal tamponade. In the third group pars plana vitrectomy with internal as well as external tamponade was done. Follow-up was for a minimal of six months.

Results: Anatomical attachment was achieved in 84% cases. With grades B and C we had 100% results. Regarding functional results, the final visual acuity was > 6/60 in 12% cases. It was between 1/60 and 6/60 in 52% and perception and projection of light or finger counting in 28% cases. Projection became faulty in two cases, which developed extensive PVR post-operatively. There were few post-operative complications. Cellophane maculopathy was seen in 8% cases and secondary glaucoma due to post-operative uveitis in 4% cases. 16% had retinal re-detachment and macular pucker was observed in 4% cases. There were 8% cases in which posterior sub-capsular opacities were seen. No gross complications were seen in 60% cases.

Conclusion: Cases of PVR grade B can be well managed with scleral buckling procedures. In patients who present with PVR grade C, the chances of further progression of the proliferative process are highest. Eyes with PVR grade D were once considered as blind eyes are well managed with pars plana vitrectomy, airfluid exchange and with external or internal tamponade.