Outcomes of 23-gauge pars plana vitrectomy in combined scleral buckling and vitrectomy for complex rhegmatogenous retinal detachments

Rhegmatogenous retinal detachments associated with proliferative vitreoretinopathy, giant retinal tears, ocular trauma, proliferative diabetic retinopathy, or necrotizing retinitis are considered more complex than those without these factors. The aim of the current review is to address the surgical outcomes and complications of 23-gauge pars plana vitrectomy with scleral buckling (23GPPV/SB) for repair of these complex retinal detachments. This retrospective study involved 54 eyes of 53 patients who underwent 23GPPV/SB between July 2007 and September 2009. Preoperative diagnosis, surgical technique, preoperative and postoperative visual acuities, intraoperative and postoperative complications, and anatomic reattachment rates were examined. Fifty-four eyes of 53 patients were reviewed in this study and indications for surgery varied. Mean logarithm of the minimal angle of resolution (logMAR) pre- and post-operative visual acuities were 1.166 (20/293) and 0.780 (20/120), respectively, which led to a statistically significant improvement in logMAR (P=0.0165). Single operation and final reattachment rates were 87% (47 of 54 eyes) and 100%, respectively. Postoperative complications included choroidal effusion/hemorrhage (14.8%, 8 of 54 eyes) and vitreous hemorrhage (11.1%, 6 of 54 eyes). Other more infrequent complications included hyphema (9.3%, 5 of 54 eyes), hypotony (5.6%, 3 of 54 eyes) and ocular hypertension > 35 mmHg (3.7%, 2 of 54 eyes). A total of 31.5% (17 of 54 eyes) of patients had a complication in the postoperative time period, but 58.8% of these resolved spontaneously without requiring an intervention. 23GPPV/SB may be considered for complex retinal detachment repair with good anatomic reattachment rates, but with relatively high complication rates.